Provider Demographics
NPI:1376900092
Name:HOLLOWAY, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELIZABETH
Other - Last Name:SUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3244 32ND ST
Mailing Address - Street 2:APT2
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2645
Mailing Address - Country:US
Mailing Address - Phone:610-506-7719
Mailing Address - Fax:
Practice Address - Street 1:1516 E YESLER WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5633
Practice Address - Country:US
Practice Address - Phone:610-506-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005227171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist