Provider Demographics
NPI:1710549894
Name:HOLLOWAY, VERONICA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 212TH ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-2671
Mailing Address - Country:US
Mailing Address - Phone:515-708-0348
Mailing Address - Fax:
Practice Address - Street 1:1301 CENTER ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1004
Practice Address - Country:US
Practice Address - Phone:515-241-0982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG155254363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health