Provider Demographics
NPI:1851871354
Name:HOLLAND, LORI J (LAC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1000 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3245
Mailing Address - Country:US
Mailing Address - Phone:402-827-1355
Mailing Address - Fax:
Practice Address - Street 1:1000 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3245
Practice Address - Country:US
Practice Address - Phone:402-827-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist