Provider Demographics
NPI:1932641602
Name:HOLLOWAY, EMILY GRETCHEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GRETCHEN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 GREEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8213
Mailing Address - Country:US
Mailing Address - Phone:662-934-0206
Mailing Address - Fax:
Practice Address - Street 1:287 GREEN OAK LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8213
Practice Address - Country:US
Practice Address - Phone:662-934-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865415163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics