Provider Demographics
NPI:1437362084
Name:HOLLAND, MARY JO (CFNP)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PROFESSORS ROW
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5816
Mailing Address - Country:US
Mailing Address - Phone:617-627-3350
Mailing Address - Fax:617-627-3592
Practice Address - Street 1:124 PROFESSORS ROW
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5816
Practice Address - Country:US
Practice Address - Phone:617-627-3350
Practice Address - Fax:617-627-3592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily