Provider Demographics
NPI:1376762658
Name:HOLLAND, DENISE MARIA (LMP NCTMB)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LMP NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2757
Mailing Address - Country:US
Mailing Address - Phone:509-665-0126
Mailing Address - Fax:
Practice Address - Street 1:914 PLUM ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2757
Practice Address - Country:US
Practice Address - Phone:509-665-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA156390OtherLABOR AND INDUSTRIES