Provider Demographics
NPI:1083188197
Name:HOLLAND, LISA MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 H ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3441
Mailing Address - Country:US
Mailing Address - Phone:916-936-2229
Mailing Address - Fax:916-307-4626
Practice Address - Street 1:4250 H ST STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3441
Practice Address - Country:US
Practice Address - Phone:916-936-2229
Practice Address - Fax:916-307-4626
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584142163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant