Individual
MS. MARY PAT HOLLER-BIBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
718 OAK ST, GRAND FORKS, ND 58201-4460
(218) 230-0070
(800) 958-7702
Mailing address
10900 PEARL RD STE C1, STRONGSVILLE, OH 44136-3349
(440) 268-8422
(440) 268-8420
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
NP1338690
MN
363LF0000X
Family Nurse Practitioner
Primary
R26553
ND
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
2010011783
MN
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
NUR-APRN-LIC-153741
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17981
ND BC/BS
ND
01
—
50000686
RR MEDICARE
ND
05
—
604715700
—
MN
01
—
68D22CE
MN BC/BS
MN
05
—
HE1472284
—
ND
05
—
PENDING
—
OH
Enumeration date
04/26/2006
Last updated
06/12/2020
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