Provider Demographics
NPI:1003262734
Name:HOLETS, KATHLEEN SUE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUE
Last Name:HOLETS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 BARRETT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1313
Mailing Address - Country:US
Mailing Address - Phone:651-600-7715
Mailing Address - Fax:
Practice Address - Street 1:1935 COUNTY ROAD B2 W
Practice Address - Street 2:SUITE 64
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2729
Practice Address - Country:US
Practice Address - Phone:612-465-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1226317163W00000X
MNCNP4522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse