Healthcare Provider Details

I. General information

NPI: 1619964566
Provider Name (Legal Business Name): MS. PATRICE LYNN HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 NE GOLDENROD AVE
BREMERTON WA
98311-3914
US

IV. Provider business mailing address

2124 NE GOLDENROD AVE
BREMERTON WA
98311-3914
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-8321
  • Fax:
Mailing address:
  • Phone: 360-307-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberN/A
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: