Provider Demographics
NPI:1114420163
Name:HOLLAND, SHANNON MARTIN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARTIN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6707 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2566
Mailing Address - Country:US
Mailing Address - Phone:912-335-1699
Mailing Address - Fax:
Practice Address - Street 1:6707 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2566
Practice Address - Country:US
Practice Address - Phone:912-335-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN095215164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse