Provider Demographics
NPI:1225250095
Name:HOLLOWAY, BETTY LEE (APN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:LEE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WELLESLEY ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3257
Mailing Address - Country:US
Mailing Address - Phone:973-976-1555
Mailing Address - Fax:973-275-4606
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:M219
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-3342
Practice Address - Fax:972-972-1649
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care