Provider Demographics
NPI:1356712822
Name:HOLLAND, MARIANNA (CNM)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 W PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2510
Mailing Address - Country:US
Mailing Address - Phone:623-748-7655
Mailing Address - Fax:602-926-0999
Practice Address - Street 1:5622 W PALMAIRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2510
Practice Address - Country:US
Practice Address - Phone:623-748-7655
Practice Address - Fax:602-926-0999
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT99618367A00000X
MT101198367A00000X
AZAP11727367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife