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NPI Code Detail

MEDICARE: MRS. NICOLE S HOLLANDSMITH RDH

MEDICARE: MRS. NICOLE S HOLLANDSMITH RDH
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
1124Q00000XDental Hygienist5923NC

General Provider Information

NPI Number : 1962496729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE S HOLLANDSMITH RDH
Provider Business Mailing Address
First Line : 2014 LIVINGSTON ST
Second Line :
City : SUFFOLK
State : VA
Zip : 23435
Country : US
Telephone Number : 404-759-4454
Fax Number :
Provider Business Practice Location Address
First Line : 1647 ADMIRAL TAUSSIG BLVD
Second Line :
City : NORFOLK
State : VA
Zip : 23511-2803
Country : US
Telephone Number : 757-953-8515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 12/23/2009

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