Provider Demographics
NPI:1275663320
Name:SLOAN, HOLIDAY ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:HOLIDAY
Middle Name:ANNE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:WA
Mailing Address - Zip Code:98859-0085
Mailing Address - Country:US
Mailing Address - Phone:509-486-4909
Mailing Address - Fax:509-486-2423
Practice Address - Street 1:165 RUFF ROAD
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:WA
Practice Address - Zip Code:98859
Practice Address - Country:US
Practice Address - Phone:509-486-4909
Practice Address - Fax:509-486-2423
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist