Provider Demographics
NPI:1427014901
Name:HOLLAND, MARYLYNN (RN, CPNP, APN)
Entity Type:Individual
Prefix:
First Name:MARYLYNN
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:RN, CPNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5050
Mailing Address - Country:US
Mailing Address - Phone:479-785-2825
Mailing Address - Fax:479-782-6630
Practice Address - Street 1:3222 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5050
Practice Address - Country:US
Practice Address - Phone:479-785-2825
Practice Address - Fax:479-782-6630
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00170163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics