Provider Demographics
NPI:1760247332
Name:HOLLAND, JASEN OSBORN SR
Entity Type:Individual
Prefix:
First Name:JASEN
Middle Name:OSBORN
Last Name:HOLLAND
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4983 BENNING RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5802
Mailing Address - Country:US
Mailing Address - Phone:202-320-6980
Mailing Address - Fax:
Practice Address - Street 1:4983 BENNING RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5802
Practice Address - Country:US
Practice Address - Phone:202-320-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant