MEDICARE: MS. ALICE RACHEL HOLLAND APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	VP005689B	PA
2	363LF0000X	Family Nurse Practitioner	5516	CT

General Provider Information

NPI Number	:	1588831879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE RACHEL HOLLAND APRN

Provider Business Mailing Address
First Line	:	500 COLLEGE AVE
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8061
Fax Number	:	610-690-5724

Provider Business Practice Location Address
First Line	:	500 COLLEGE AVE
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8061
Fax Number	:	610-690-5724

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	10/30/2015

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