Provider Demographics
NPI:1679397707
Name:HOLVERSON, KRISTEENA KATHLEEN
Entity type:Individual
Prefix:
First Name:KRISTEENA
Middle Name:KATHLEEN
Last Name:HOLVERSON
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 1:900 FULTON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4517
Mailing Address - Country:US
Mailing Address - Phone:916-484-3570
Mailing Address - Fax:
Practice Address - Street 1:900 FULTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4517
Practice Address - Country:US
Practice Address - Phone:916-484-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker