Provider Demographics
NPI:1962027466
Name:HOLLOWAY, AMBER WILLIS (APRN-CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:WILLIS
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-3038
Mailing Address - Country:US
Mailing Address - Phone:307-745-8991
Mailing Address - Fax:
Practice Address - Street 1:2710 HARNEY ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-3038
Practice Address - Country:US
Practice Address - Phone:307-745-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY45993367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife