MEDICARE: PAMELA DENESE HOLLAND CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	240922	TX
2	367500000X	Certified Registered Nurse Anesthetist	AP103210	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ144000&AZ480280	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	750332	OTHER	AZ	AHCCS #
3	0480280	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1609804467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA DENESE HOLLAND CRNA

Provider Business Mailing Address
First Line	:	11 BYRON NELSON
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1726
Country	:	US
Telephone Number	:	602-793-3380
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 BYRON NELSON
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1726
Country	:	US
Telephone Number	:	602-793-3380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/18/2016

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Directions to “ PAMELA DENESE HOLLAND CRNA” Practice Location

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