Active NPI
Patrice Lynn Holland
- Prosthetics Case Management
- Bremerton, WA
National Provider Identifier
1619964566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- N/A
- Practice address
- 2124 NE Goldenrod Ave
Bremerton, WA 98311-3914 - Phone
- (360) 307-8321
- NPI assigned
- Oct 5, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | N/A | WA | Primary |
Addresses
Primary practice location
2124 NE Goldenrod Ave
Bremerton, WA 98311-3914
Mailing address
2124 NE Goldenrod Ave
Bremerton, WA 98311-3914
Phone (360) 307-8321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9053448 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N/A | WA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207872000000",
"number": "1619964566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2124 NE GOLDENROD AVE",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983113914",
"telephone_number": "360-307-8321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2124 NE GOLDENROD AVE",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983113914",
"telephone_number": "360-307-8321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND",
"first_name": "PATRICE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-05",
"last_updated": "2008-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "WA",
"license": "N/A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9053448",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.