1295769297 NPI number — YOLANDA F HOLLER-MANAGAN MD

Table of content: YOLANDA F HOLLER-MANAGAN MD (NPI 1295769297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295769297 NPI number — YOLANDA F HOLLER-MANAGAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLER-MANAGAN
Provider First Name:
YOLANDA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295769297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 N. WINFIELD ROAD
Provider Second Line Business Mailing Address:
PEDIATRIC OUTPATIENT, EAST CLINIC
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-933-4954
Provider Business Mailing Address Fax Number:
630-933-4225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 N. WINFIELD ROAD
Provider Second Line Business Practice Location Address:
PEDIATRIC OUTPATIENT, EAST CLINIC
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-933-4954
Provider Business Practice Location Address Fax Number:
630-933-4225
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  036.101944 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)