Provider Demographics
NPI:1881294486
Name:HOLLOWAY, GRETCHEN (APRN)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5141
Mailing Address - Country:US
Mailing Address - Phone:860-585-3560
Mailing Address - Fax:860-585-3971
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5141
Practice Address - Country:US
Practice Address - Phone:860-585-3560
Practice Address - Fax:860-585-3971
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9290363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology