Provider Demographics
NPI:1144705195
Name:HOLLOWAY, HOLLEY LEE (RD)
Entity type:Individual
Prefix:MRS
First Name:HOLLEY
Middle Name:LEE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 RICH DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1131
Mailing Address - Country:US
Mailing Address - Phone:248-421-9253
Mailing Address - Fax:248-524-0626
Practice Address - Street 1:2050 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1757
Practice Address - Country:US
Practice Address - Phone:248-524-1270
Practice Address - Fax:248-524-0626
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal