Provider Demographics
NPI:1033465117
Name:FIX, HOLLY C (CPM, LM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:FIX
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 CAVELL LANE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:612-244-9928
Mailing Address - Fax:
Practice Address - Street 1:1901 44TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1209
Practice Address - Country:US
Practice Address - Phone:612-338-2784
Practice Address - Fax:651-383-4135
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula