Provider Demographics
NPI:1871742825
Name:HOLLEN, CAMILLA EARLENE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:EARLENE
Last Name:HOLLEN
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 N SECTOR CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2859
Mailing Address - Country:US
Mailing Address - Phone:540-542-6208
Mailing Address - Fax:540-542-6210
Practice Address - Street 1:1057 MARTINSBURG PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-5409
Practice Address - Country:US
Practice Address - Phone:540-665-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002830363AM0700X
WV01514363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871742825Medicaid
P00765854OtherRAILROAD MEDICARE
VA1871742825Medicaid