Basic Information
| Provider Information | |||||||||
| NPI: | 1437825007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARPLE | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 KENTUCKY AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554262150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517569886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2426 W BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554111735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123028200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2021 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8358 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.