Provider Demographics
NPI:1023075975
Name:HOLLER-BIBEL, MARY PAT (FNP)
Entity type:Individual
Prefix:MS
First Name:MARY PAT
Middle Name:
Last Name:HOLLER-BIBEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 PEARL RD STE C1
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3349
Mailing Address - Country:US
Mailing Address - Phone:440-268-8422
Mailing Address - Fax:440-268-8420
Practice Address - Street 1:718 OAK ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4460
Practice Address - Country:US
Practice Address - Phone:218-230-0070
Practice Address - Fax:800-958-7702
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNP1338690363LF0000X
MN2010011783364SP0808X
MTNUR-APRN-LIC-153741364SP0808X
NDR26553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
MN68D22CEOtherMN BC/BS
ND17981OtherND BC/BS
ND50000686OtherRR MEDICARE
MN604715700Medicaid
NDHE1472284Medicaid
OHPENDINGMedicare PIN