Basic Information
Provider Information
NPI: 1710938105
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLLAND
FirstName: LEAH
MiddleName: NICOLE
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 225 S UNION BLVD
Address2: SECOND FLOOR
City: COLORADO SPRINGS
State: CO
PostalCode: 809103184
CountryCode: US
TelephoneNumber: 7196325700
FaxNumber:  
Practice Location
Address1: 225 S UNION BLVD
Address2: SECOND FLOOR
City: COLORADO SPRINGS
State: CO
PostalCode: 809103184
CountryCode: US
TelephoneNumber: 7196325700
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2006
LastUpdateDate: 04/04/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102XRN114074AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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