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NPI Code Detail

MEDICARE: MS. IRENE ANN HOLLAND RN, PMHNP

MEDICARE: MS. IRENE ANN HOLLAND RN, PMHNP
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
1163W00000XRegistered Nurse000033401RNOR
2363LP0808XPsychiatric/Mental Health Nurse Practitioner200550159NPPMHNP-PPOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730170085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IRENE ANN HOLLAND RN, PMHNP
Provider Business Mailing Address
First Line : 58646 MCNULTY WAY
Second Line :
City : SAINT HELENS
State : OR
Zip : 97051-6210
Country : US
Telephone Number : 503-397-5211
Fax Number : 503-397-5373
Provider Business Practice Location Address
First Line : 58646 MCNULTY WAY
Second Line :
City : SAINT HELENS
State : OR
Zip : 97051-6210
Country : US
Telephone Number : 503-397-5211
Fax Number : 503-397-5373
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 08/01/2011

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