Provider Demographics
NPI:1730447939
Name:HOLL, ELIZABETH MARY (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:HOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15025 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-2603
Mailing Address - Country:US
Mailing Address - Phone:720-771-7862
Mailing Address - Fax:
Practice Address - Street 1:1900 BOISE AVE STE 420
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-820-3212
Practice Address - Fax:970-820-6162
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
CODR.0057877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program