Individual
THERESA CLARE HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3118 E 10TH ST, SUITE B, JEFFERSONVILLE, IN 47130-5904
(812) 282-6979
(812) 282-6998
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28108443A
IN
363L00000X
Nurse Practitioner
Primary
71004116
IN
363LA2200X
Adult Health Nurse Practitioner
71004116
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201121090
—
IN
Enumeration date
08/29/2012
Last updated
07/25/2015
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