Provider Demographics
NPI:1447925755
Name:MINNESOTA HOLISTIC CLINIC LLC
Entity type:Organization
Organization Name:MINNESOTA HOLISTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:STARLLONE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:651-410-7955
Mailing Address - Street 1:25282 HAZELWOOD DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2797
Mailing Address - Country:US
Mailing Address - Phone:651-410-7955
Mailing Address - Fax:
Practice Address - Street 1:25282 HAZELWOOD DR UNIT 1
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2797
Practice Address - Country:US
Practice Address - Phone:651-410-7955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty