Provider Demographics
NPI:1790157923
Name:MINNICK-BISHOP, HOLLY R (PMHNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:R
Last Name:MINNICK-BISHOP
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6212 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8368
Mailing Address - Country:US
Mailing Address - Phone:253-983-8507
Mailing Address - Fax:253-983-8576
Practice Address - Street 1:6212 75TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8368
Practice Address - Country:US
Practice Address - Phone:253-983-8507
Practice Address - Fax:253-983-8576
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#AP60594013,363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health