Provider Demographics
NPI:1871608687
Name:WEISS-HOLZBAUER, EDITH ANN (CNM)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:ANN
Last Name:WEISS-HOLZBAUER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 ETNA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1210
Mailing Address - Country:US
Mailing Address - Phone:612-709-3311
Mailing Address - Fax:612-709-3311
Practice Address - Street 1:142 3RD ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2502
Practice Address - Country:US
Practice Address - Phone:605-554-1020
Practice Address - Fax:605-554-1021
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 120054-0367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS43075Medicare UPIN
MN420000492Medicare ID - Type Unspecified