Provider Demographics
NPI:1689990525
Name:HOLLOWAY, SUMMER-SKYY (LPN)
Entity Type:Individual
Prefix:
First Name:SUMMER-SKYY
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 AUTUMN POINT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3068
Mailing Address - Country:US
Mailing Address - Phone:631-796-2427
Mailing Address - Fax:
Practice Address - Street 1:6813 AUTUMN POINT DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3068
Practice Address - Country:US
Practice Address - Phone:631-796-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256384-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse