1619381209 NPI number — DR. KATHLEEN JOAN HOLLAND M.D., M.P.H.

Table of content: DR. KATHLEEN JOAN HOLLAND M.D., M.P.H. (NPI 1619381209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619381209 NPI number — DR. KATHLEEN JOAN HOLLAND M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
KATHLEEN
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORNFIELD
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., M.P.H.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619381209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 MILL ST # MS 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-5262
Provider Business Mailing Address Fax Number:
775-982-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 PRINGLE WAY STE 505
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-329-4600
Provider Business Practice Location Address Fax Number:
775-329-4992
Provider Enumeration Date:
06/11/2014

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: 207RG0100X , with the licence number:  20499 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X , with the licence number: 20499 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20499 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".