Provider Demographics
NPI:1013227933
Name:HOLLAND-BARNES, JENNIFER REBECCA (LMP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:HOLLAND-BARNES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 SE VAN SKIVER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8517
Mailing Address - Country:US
Mailing Address - Phone:360-621-2934
Mailing Address - Fax:
Practice Address - Street 1:1621 SE VAN SKIVER RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8517
Practice Address - Country:US
Practice Address - Phone:360-621-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60182494171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor