Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 201250054NP | OR |
NPI | 1023380979 |
---|---|
Provider Name | Mr. Miles Percy Holland |
First Address | Portland, OR 97224-7187 |
Second Address | Portland, OR 97224-7187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2012 |
Last Update Date | 11/07/2017 |