Provider Demographics
NPI:1891300190
Name:HOLL, MORGAN (RD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:HOLL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-1833
Mailing Address - Country:US
Mailing Address - Phone:703-552-2722
Mailing Address - Fax:703-564-8567
Practice Address - Street 1:20130 LAKEVIEW CENTER PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5904
Practice Address - Country:US
Practice Address - Phone:703-552-2722
Practice Address - Fax:703-564-8567
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86173621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered