Provider Demographics
NPI:1639740558
Name:HOLLAND, HAILEY MARLYCE (MFCS, RDN, LD)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:MARLYCE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MFCS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WAR ADMIRAL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-2005
Mailing Address - Country:US
Mailing Address - Phone:507-456-3974
Mailing Address - Fax:
Practice Address - Street 1:143 WAR ADMIRAL LN
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2005
Practice Address - Country:US
Practice Address - Phone:507-456-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA86050880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered