Provider Demographics
NPI:1184905200
Name:HOLLAND, PAMELA DIANE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DIANE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ROYAL LN
Mailing Address - Street 2:NONE
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3958
Mailing Address - Country:US
Mailing Address - Phone:912-306-4619
Mailing Address - Fax:
Practice Address - Street 1:138 ROYAL LN
Practice Address - Street 2:NONE
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-3958
Practice Address - Country:US
Practice Address - Phone:912-306-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19411880174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN