Individual provider Active NPI

Shannon M Holland, MSN

  • Pediatric Nurse Practitioner
  • Morristown, NJ
National Provider Identifier
1457484289
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
26NJ00008300 Issued in NJ
Practice address
100 Madison Ave
Morristown, NJ 07960-6136
Phone
(973) 971-7182
NPI assigned
Mar 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 26NJ00008300 NJ Primary

Addresses

Primary practice location

100 Madison Ave
Morristown, NJ 07960-6136

Mailing address

PO Box 23831
Newark, NJ 07189-0001
Phone (973) 971-7182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070605000358 NJ Practitioner - Nurse Practitioner 7113025784 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00008300NJMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group CurrentSince Jan 1, 2007 Accepting new patients
Specialty Care of Practice Associates,PA Past Accepting new patients
Practice Associates,Inc Past Accepting new patients

Locations

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

100 Madison Ave
Fl 3
Morristown, NJ 07960
Phone (908) 522-3523

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457484289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23831",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071890001",
            "telephone_number": "973-971-7182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "MORRISTOWN",
            "state": "NJ",
            "postal_code": "079606136",
            "telephone_number": "973-971-7182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "SHANNON",
        "middle_name": "M",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NJ00008300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, NJ

Sources for this page

Verify at the official NPI Registry.