Provider Demographics
NPI:1124318894
Name:HOLLAND, MARY A (MPH, RD, CSO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MPH, RD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWTHORNE LN
Mailing Address - Street 2:PRESBYTERIAN CANCER CENTER
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2515
Mailing Address - Country:US
Mailing Address - Phone:704-384-5374
Mailing Address - Fax:704-384-5679
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:PRESBYTERIAN CANCER CENTER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-5374
Practice Address - Fax:704-384-5679
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002215133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered