Provider Demographics
NPI:1588495253
Name:BADE, HOLLY IRENE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:IRENE
Last Name:BADE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:IRENE
Other - Last Name:GIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:58547 158TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56065-5675
Mailing Address - Country:US
Mailing Address - Phone:507-304-2388
Mailing Address - Fax:
Practice Address - Street 1:410 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4592
Practice Address - Country:US
Practice Address - Phone:507-304-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry