Provider Demographics
NPI:1740301704
Name:PISSERI, HOLLIE BETH (CNP)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:BETH
Last Name:PISSERI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:BETH
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 HARVARD ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0363
Mailing Address - Country:US
Mailing Address - Phone:614-284-2698
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-0200
Practice Address - Fax:612-863-0235
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0286028363LA2200X
MN6228363L00000X
MNONCOLOGY363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6228OtherCERTIFIED NURSE PRACTITIONER
0286028OtherNURSE PRACTITIONER CERTIFICATION
0286028OtherNURSE PRACTITIONER CERTIFICATION