Provider Demographics
NPI:1558615724
Name:HOLLOWAY, NAIMA
Entity Type:Individual
Prefix:
First Name:NAIMA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 RADIERE LOOP
Mailing Address - Street 2:APT D
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1829
Mailing Address - Country:US
Mailing Address - Phone:910-987-5274
Mailing Address - Fax:
Practice Address - Street 1:3134 RADIERE LOOP
Practice Address - Street 2:APT D
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1829
Practice Address - Country:US
Practice Address - Phone:910-987-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6437361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse