Provider Demographics
NPI:1508017120
Name:HOLLAND, CATHERINE BLACKWELL (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:BLACKWELL
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:BLACKWELL
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14151 GLEN ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-6411
Mailing Address - Country:US
Mailing Address - Phone:225-664-9968
Mailing Address - Fax:
Practice Address - Street 1:14151 GLEN ELLIS RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6411
Practice Address - Country:US
Practice Address - Phone:225-664-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2608363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010086OtherPRESCRIPTIVE AUTHORITY
LA2608OtherADVANCED PRACTICE