Provider Demographics
NPI:1295887370
Name:HOLMEN, SUSANNE ELAINE
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:ELAINE
Last Name:HOLMEN
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 1:23650 GLORY TRAIL
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-732-3088
Mailing Address - Fax:
Practice Address - Street 1:515 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1210
Practice Address - Country:US
Practice Address - Phone:218-366-9229
Practice Address - Fax:218-237-2520
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner