Provider Demographics
NPI:1871753202
Name:LAURIN, HOLLAND NELL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HOLLAND
Middle Name:NELL
Last Name:LAURIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HOLLAND
Other - Middle Name:NELL
Other - Last Name:HURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12419 SMOKEY MOUNTAIN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7273
Mailing Address - Country:US
Mailing Address - Phone:505-299-6409
Mailing Address - Fax:
Practice Address - Street 1:12419 SMOKEY MOUNTAIN WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7273
Practice Address - Country:US
Practice Address - Phone:505-299-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0025363A00000X
CO1978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM301539Medicare UPIN
NMNMB0002Medicare PIN