1508017120 NPI number — MRS. CATHERINE BLACKWELL HOLLAND ADULT NURSE PRACTITI

Table of content: MRS. CATHERINE BLACKWELL HOLLAND ADULT NURSE PRACTITI (NPI 1508017120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508017120 NPI number — MRS. CATHERINE BLACKWELL HOLLAND ADULT NURSE PRACTITI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
CATHERINE
Provider Middle Name:
BLACKWELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ADULT NURSE PRACTITI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLAND
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
BLACKWELL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508017120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14151 GLEN ELLIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALKER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70785-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-664-9968
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14151 GLEN ELLIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70785-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-664-9968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2008

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: 363LA2200X , with the licence number:  2608 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010086 . This is a "PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2608 . This is a "ADVANCED PRACTICE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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