Provider Demographics
NPI:1821346917
Name:HOLLOWAY, LATANYA
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:
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 1:4550 S NICHOLSON AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4550 S NICHOLSON AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1361
Practice Address - Country:US
Practice Address - Phone:414-241-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI185926-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse