Provider Demographics
NPI:1154920700
Name:HOLLAND, MONTINA
Entity type:Individual
Prefix:
First Name:MONTINA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 DIANNA RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2227
Mailing Address - Country:US
Mailing Address - Phone:301-675-7158
Mailing Address - Fax:
Practice Address - Street 1:2906 NAYLOR RD SE APT A153
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2646
Practice Address - Country:US
Practice Address - Phone:301-675-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide