Provider Demographics
NPI:1952432023
Name:HOLLAND, MARY BETH (APRN)
Entity type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1654
Mailing Address - Country:US
Mailing Address - Phone:402-571-2234
Mailing Address - Fax:402-496-0489
Practice Address - Street 1:3341 N 107TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3664
Practice Address - Country:US
Practice Address - Phone:402-496-0088
Practice Address - Fax:402-496-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250886-00Medicaid
NE273542Medicare ID - Type Unspecified
NES-81701Medicare UPIN