Individual
ELIZABETH KOONTZ HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 713-5424
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 713-5424
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000101509
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7338641
AETNA
—
01
—
94676
MEDCOST
NC
Enumeration date
12/13/2005
Last updated
06/13/2012
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