Provider Demographics
NPI:1619964566
Name:HOLLAND, PATRICE LYNN
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:LYNN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 NE GOLDENROD AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3914
Mailing Address - Country:US
Mailing Address - Phone:360-307-8321
Mailing Address - Fax:
Practice Address - Street 1:2124 NE GOLDENROD AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3914
Practice Address - Country:US
Practice Address - Phone:360-307-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN/A1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9053448Medicaid
WA4591580001Medicare NSC