Provider Demographics
NPI:1740925163
Name:HOLMGREN, KEVIN JOHN (NREMT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:HOLMGREN
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:JOHN
Other - Last Name:HOLMGREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NREMT
Mailing Address - Street 1:308 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-7406
Mailing Address - Country:US
Mailing Address - Phone:701-822-1877
Mailing Address - Fax:
Practice Address - Street 1:308 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7406
Practice Address - Country:US
Practice Address - Phone:701-822-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDE3633212374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND153102OtherND EMS