Provider Demographics
NPI:1922728880
Name:ENGEL, HOLLY LYNN LISOWSKI (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN LISOWSKI
Last Name:ENGEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LYNN LISOWSKI
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HOLLY LYNN LISOWSKI
Mailing Address - Street 1:7117 WINDGATE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1529
Mailing Address - Country:US
Mailing Address - Phone:608-863-0982
Mailing Address - Fax:
Practice Address - Street 1:7117 WINDGATE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1529
Practice Address - Country:US
Practice Address - Phone:608-863-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2349934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI178872-30OtherRN LICENSE
MN2349934OtherRN LICENSE