Basic Information
Provider Information
NPI: 1811367626
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLLAND
FirstName: OLIVIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3330 PEACH ST
Address2: SUITE 106
City: ERIE
State: PA
PostalCode: 165082769
CountryCode: US
TelephoneNumber: 8148775570
FaxNumber: 8148775571
Practice Location
Address1: 565 COAL VALLEY RD
Address2:  
City: JEFFERSON HILLS
State: PA
PostalCode: 150253703
CountryCode: US
TelephoneNumber: 4122676810
FaxNumber: 4122676817
Other Information
ProviderEnumerationDate: 10/06/2015
LastUpdateDate: 10/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA057946PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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