Provider Demographics
NPI:1609871110
Name:HOLLAND, LORRETTA R (NP)
Entity Type:Individual
Prefix:MRS
First Name:LORRETTA
Middle Name:R
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:J
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5900 LAKE WRIGHT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1871
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:300 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 314
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-549-4403
Practice Address - Fax:757-549-4332
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024128931363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007792476Medicaid
VA1609871110Medicaid
VA1002186NOtherOPTIMA
VA017843V25Medicare PIN
VA1002186NOtherOPTIMA