Provider Demographics
NPI:1326067844
Name:PIKE, HOLLY J (PNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:PIKE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:763-873-3000
Mailing Address - Fax:612-873-1928
Practice Address - Street 1:715 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1210
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-873-1928
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1024632163W00000X
MN2388363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9D455PIOtherBLUE CROSS BLUE SHIELD
MN12-12534OtherMEDICA
MN311542900Medicaid
MN9D455PIOtherBLUE CROSS BLUE SHIELD
MN12-12534OtherMEDICA
MN500003993Medicare Oscar/Certification