Basic Information
| Provider Information | |||||||||
| NPI: | 1295762821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 SHANDREW DR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303574852 | ||||||||
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| Practice Location | |||||||||
| Address1: | 810 BIESTERFIELD RD | ||||||||
| Address2: | EBERLE BUILDING, SUITE 605 | ||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600077312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473646724 | ||||||||
| FaxNumber: | 8473646720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 85000977 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.