Provider Demographics
NPI:1295298362
Name:HOLWAY, TRICIA MAY LOPEZ (EMT BASIC)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:MAY LOPEZ
Last Name:HOLWAY
Suffix:
Gender:F
Credentials:EMT BASIC
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:MAY LOPEZ
Other - Last Name:CAPISTRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT BASIC
Mailing Address - Street 1:2407 193RD ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-3418
Mailing Address - Country:US
Mailing Address - Phone:916-606-4382
Mailing Address - Fax:
Practice Address - Street 1:2407 193RD ST E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-3418
Practice Address - Country:US
Practice Address - Phone:916-606-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAE3120523146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic