Provider Demographics
NPI:1861593907
Name:HOLLAND, JANE G (NP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:G
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HAVEN COURT
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-257-5605
Mailing Address - Fax:
Practice Address - Street 1:640 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:PA
Practice Address - Zip Code:18936
Practice Address - Country:US
Practice Address - Phone:215-368-4350
Practice Address - Fax:215-368-2768
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005081C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00185875OtherRR MEDICARE
PAH036370OtherBLUE SHIELD
PAH036370OtherBLUE SHIELD
PA0441457M9Medicare ID - Type Unspecified