Provider Demographics
NPI:1609839885
Name:HOLLAND, SUE ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 109TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-0885
Mailing Address - Country:US
Mailing Address - Phone:806-798-2503
Mailing Address - Fax:
Practice Address - Street 1:3806 109TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-0885
Practice Address - Country:US
Practice Address - Phone:806-798-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR465479367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006925401Medicaid
TX00C11KMedicare ID - Type Unspecified