Healthcare Provider Details

I. General information

NPI: 1588413702
Provider Name (Legal Business Name): COURTNEY DAWN HOLLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N OAKLAND ST
SAINT JOHNS MI
48879-1063
US

IV. Provider business mailing address

9674 E REMUS RD
MOUNT PLEASANT MI
48858-8103
US

V. Phone/Fax

Practice location:
  • Phone: 810-487-5571
  • Fax:
Mailing address:
  • Phone: 586-823-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704370371
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704370371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: