1912122722 NPI number — MRS. MARILYN DIANE HOLLOWAY R.N.

Table of content: (NPI 1427824598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912122722 NPI number — MRS. MARILYN DIANE HOLLOWAY R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
MARILYN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
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:
1912122722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2987 PERRIN HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37709-5632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-932-2484
Provider Business Mailing Address Fax Number:
865-397-1246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
931 INDUSTRIAL PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANDRIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37725-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-932-2484
Provider Business Practice Location Address Fax Number:
865-397-1246
Provider Enumeration Date:
04/16/2007

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: 163W00000X , with the licence number:  RN0000100506 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN0000100506 . This is a "MULTISTATE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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