Provider Demographics
NPI:1851441836
Name:HOLLAND, WENDY JEAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JEAN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 WATERS AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-354-7676
Mailing Address - Fax:912-354-6040
Practice Address - Street 1:6602 WATERS AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2778
Practice Address - Country:US
Practice Address - Phone:912-354-7676
Practice Address - Fax:912-354-6040
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102280363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900281CMedicaid
GAS77713Medicare UPIN
GA000900281CMedicaid