Provider Demographics
NPI:1639783483
Name:HOLLOWAY, DORIS (CERTIFIED NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23110 DREWRY RD
Mailing Address - Street 2:
Mailing Address - City:DREWRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23844-2073
Mailing Address - Country:US
Mailing Address - Phone:757-915-5192
Mailing Address - Fax:
Practice Address - Street 1:23110 DREWRY RD
Practice Address - Street 2:
Practice Address - City:DREWRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:23844-2073
Practice Address - Country:US
Practice Address - Phone:757-915-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X, 376K00000X
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide