Provider Demographics
NPI:1952708976
Name:HOLLAND, MARY R (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:R
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37997 GLENGROVE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1197
Mailing Address - Country:US
Mailing Address - Phone:248-788-9159
Mailing Address - Fax:
Practice Address - Street 1:41521 W 11 MILE ROAD
Practice Address - Street 2:CENTRIA HEALTHCARE LLC
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48475
Practice Address - Country:US
Practice Address - Phone:124-899-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704193175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse