Healthcare Provider Details

I. General information

NPI: 1427454602
Provider Name (Legal Business Name): BARBARA HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ARAPAHO DR
FREEPORT IL
61032-7211
US

IV. Provider business mailing address

1120 ARAPAHO DR
FREEPORT IL
61032-7211
US

V. Phone/Fax

Practice location:
  • Phone: 815-541-9681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002237
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209.012007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: