Provider Demographics
NPI:1912216706
Name:HOLLAND, NICOLE K (LPN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HILLCREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:605 HILLCREST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3680
Practice Address - Country:US
Practice Address - Phone:507-451-0290
Practice Address - Fax:507-451-0291
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL51104-9164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse