Healthcare Provider Details

I. General information

NPI: 1083188197
Provider Name (Legal Business Name): LISA MARIE HOLLAND REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 H ST STE 2
SACRAMENTO CA
95819-3441
US

IV. Provider business mailing address

4250 H ST STE 2
SACRAMENTO CA
95819-3441
US

V. Phone/Fax

Practice location:
  • Phone: 916-936-2229
  • Fax: 916-307-4626
Mailing address:
  • Phone: 916-936-2229
  • Fax: 916-307-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number584142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: