Provider Demographics
NPI:1124875828
Name:HOLLOWELL, EDDIE LEE (ACNP)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:LEE
Last Name:HOLLOWELL
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 N LAINEY LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7328
Mailing Address - Country:US
Mailing Address - Phone:602-663-1672
Mailing Address - Fax:
Practice Address - Street 1:26700 S US HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5024
Practice Address - Country:US
Practice Address - Phone:623-386-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305274363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health