Provider Demographics
NPI:1043287527
Name:HOLTON, CAROL L (FNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:HOLTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COLLEGE AVE S
Mailing Address - Street 2:3COLLEGE OF ST. BENEDICT - LOOTIE HALL
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-2001
Mailing Address - Country:US
Mailing Address - Phone:320-363-5605
Mailing Address - Fax:320-363-6396
Practice Address - Street 1:37 COLLEGE AVE SOUTH
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374
Practice Address - Country:US
Practice Address - Phone:320-363-5605
Practice Address - Fax:320-363-6396
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNR1219298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN631175000Medicaid
S90762Medicare UPIN
MN500002342Medicare ID - Type Unspecified