Provider Demographics
NPI:1659819845
Name:HOLLOWAY, COLLEEN WEEKS (PA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:WEEKS
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10956 DONNER PASS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4860
Mailing Address - Country:US
Mailing Address - Phone:530-581-8864
Mailing Address - Fax:
Practice Address - Street 1:10956 DONNER PASS RD STE 110
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4860
Practice Address - Country:US
Practice Address - Phone:530-581-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant