Provider Demographics
NPI:1114339520
Name:HOLLOWAY, DORIS LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:LYNN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N MAIN ST
Mailing Address - Street 2:BOX 436
Mailing Address - City:REESEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53579-9662
Mailing Address - Country:US
Mailing Address - Phone:920-927-5308
Mailing Address - Fax:
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:BOX 436
Practice Address - City:REESEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53579-9662
Practice Address - Country:US
Practice Address - Phone:920-927-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse