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NPI Code Detail

MEDICARE: DETTA F HOLLAND

MEDICARE: DETTA F HOLLAND
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1871614875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DETTA F HOLLAND
Provider Business Mailing Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Provider Business Practice Location Address
First Line : 211 JACKSON ST SW
Second Line :
City : CAMDEN
State : AR
Zip : 71701-3941
Country : US
Telephone Number : 870-836-5743
Fax Number : 870-836-6924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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Directions to “ DETTA F HOLLAND ” Practice Location

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