Provider Demographics
NPI:1376048942
Name:HOLLOWAY, DIANA DAWN (LVN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DAWN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:DAWN
Other - Last Name:KLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4456 FM 1991
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76665-4587
Mailing Address - Country:US
Mailing Address - Phone:254-205-3858
Mailing Address - Fax:
Practice Address - Street 1:4456 FM 1991
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665-4587
Practice Address - Country:US
Practice Address - Phone:254-205-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187114164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse