1699042317 NPI number — DARLENE HOLLOWAY ND, LMBT, CT, ST

Table of content: DARLENE HOLLOWAY ND, LMBT, CT, ST (NPI 1699042317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699042317 NPI number — DARLENE HOLLOWAY ND, LMBT, CT, ST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
DARLENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ND, LMBT, CT, ST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699042317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 KILDAIRE FARM RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-3935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-380-0023
Provider Business Mailing Address Fax Number:
919-380-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 KILDAIRE FARM RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-380-0023
Provider Business Practice Location Address Fax Number:
919-380-0023
Provider Enumeration Date:
11/23/2011

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: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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