Provider Demographics
NPI:1710681861
Name:BUCHHOLZ, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W LYNMAR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1154
Mailing Address - Country:US
Mailing Address - Phone:701-412-3972
Mailing Address - Fax:
Practice Address - Street 1:277 WEST MAIN
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078
Practice Address - Country:US
Practice Address - Phone:701-639-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist