Provider Demographics
NPI:1063462539
Name:HOLSTAD, MARCIA MCDONNELL (DSN, RN, C, FNP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:MCDONNELL
Last Name:HOLSTAD
Suffix:
Gender:F
Credentials:DSN, RN, C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 BOLES FARM LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5440
Mailing Address - Country:US
Mailing Address - Phone:770-622-9202
Mailing Address - Fax:
Practice Address - Street 1:341 PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-616-9824
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN048542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily