1023075975 NPI number — MS. MARY PAT HOLLER-BIBEL FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023075975 NPI number — MS. MARY PAT HOLLER-BIBEL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLER-BIBEL
Provider First Name:
MARY PAT
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023075975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10900 PEARL RD STE C1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRONGSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44136-3349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-268-8422
Provider Business Mailing Address Fax Number:
440-268-8420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-4460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-230-0070
Provider Business Practice Location Address Fax Number:
800-958-7702
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP1338690 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 2010011783 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: NUR-APRN-LIC-153741 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R26553 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68D22CE . This is a "MN BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17981 . This is a "ND BC/BS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 50000686 . This is a "RR MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 604715700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HE1472284 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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