Individual
JACOB HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 795-5008
Mailing address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP61294941
WA
Other
Enumeration date
08/19/2022
Last updated
08/19/2022
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