Provider Demographics
NPI:1205852811
Name:HOLLAND, ALFRED W II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:W
Last Name:HOLLAND
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FULTON ANETHESIA ASSOCIATES INC
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502
Mailing Address - Country:US
Mailing Address - Phone:419-445-1451
Mailing Address - Fax:419-445-0900
Practice Address - Street 1:FULTON ANETHESIA ASSOCIATES INC
Practice Address - Street 2:201 DITTO ST
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:419-445-1451
Practice Address - Fax:419-445-0900
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN1218589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128050OtherANTHEM
OH0242302Medicaid
OHH08202641Medicare ID - Type Unspecified