Provider Demographics
NPI:1639685373
Name:HOLLOWAY, SANDRA NAIL
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:NAIL
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 1:355 COMMON CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6143
Mailing Address - Country:US
Mailing Address - Phone:702-272-5855
Mailing Address - Fax:702-749-6334
Practice Address - Street 1:355 COMMON CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6143
Practice Address - Country:US
Practice Address - Phone:702-272-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty