Provider Demographics
NPI:1760540710
Name:HOLLAND, ANN MARIE (ND, MSOM, L AC)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:ND, MSOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3292
Mailing Address - Country:US
Mailing Address - Phone:503-504-2705
Mailing Address - Fax:888-972-3725
Practice Address - Street 1:1990 SE LADD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4757
Practice Address - Country:US
Practice Address - Phone:503-820-8040
Practice Address - Fax:888-972-3725
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00835171100000X
OR1366175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277787Medicaid