Healthcare Provider Details

I. General information

NPI: 1073086831
Provider Name (Legal Business Name): SYDNEY HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N GOWDY ST
WHITEWRIGHT TX
75491-2028
US

IV. Provider business mailing address

207 N GOWDY ST
WHITEWRIGHT TX
75491-2028
US

V. Phone/Fax

Practice location:
  • Phone: 214-695-3262
  • Fax:
Mailing address:
  • Phone: 214-695-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number345064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: