Provider Demographics
NPI:1356527014
Name:HOLLAND, MARIE ISABELLA (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ISABELLA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:ISABELLA
Other - Last Name:DEYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:45 MORRISSEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1219
Mailing Address - Country:US
Mailing Address - Phone:845-661-6916
Mailing Address - Fax:
Practice Address - Street 1:45 MORRISSEY DR
Practice Address - Street 2:
Practice Address - City:LAKE PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10537-1219
Practice Address - Country:US
Practice Address - Phone:845-284-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217936-1164W00000X
NY785986-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01779304Medicaid