Provider Demographics
NPI:1700698297
Name:HOLLAND, BONNIE (MED, ET/P)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MED, ET/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4030
Mailing Address - Country:US
Mailing Address - Phone:510-967-1642
Mailing Address - Fax:
Practice Address - Street 1:1406 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4030
Practice Address - Country:US
Practice Address - Phone:510-967-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-0687178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist