Provider Demographics
NPI:1497451181
Name:HOLLER, LISA CONSTANCE SIEWIT (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CONSTANCE SIEWIT
Last Name:HOLLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:922 16TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3220
Mailing Address - Country:US
Mailing Address - Phone:408-621-4005
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 401
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1842
Practice Address - Country:US
Practice Address - Phone:310-205-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2025-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95022108363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health