Provider Demographics
NPI:1992378681
Name:HOLLOWAY, EBONY MARSHAA
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:MARSHAA
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 1:1568 DARREN CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3102
Mailing Address - Country:US
Mailing Address - Phone:757-807-4561
Mailing Address - Fax:
Practice Address - Street 1:100 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-1802
Practice Address - Country:US
Practice Address - Phone:757-807-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)