1689850539 NPI number — MRS. DOREEN MADELEINE DAY HOLLOWAY

Table of content: MRS. DOREEN MADELEINE DAY HOLLOWAY (NPI 1689850539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689850539 NPI number — MRS. DOREEN MADELEINE DAY HOLLOWAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
DOREEN
Provider Middle Name:
MADELEINE DAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAY HOLLOWAY
Provider Other First Name:
DOREEN
Provider Other Middle Name:
MADELEINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689850539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1064 MEADOWVIEW DR
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-4821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-265-8300
Provider Business Mailing Address Fax Number:
336-667-8718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1064 MEADOWVIEW DR STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-265-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3195 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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