Provider Demographics
NPI:1194238626
Name:HOLLOWAY, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
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 1:9100 FREDERICKS HALL RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-4005
Mailing Address - Country:US
Mailing Address - Phone:540-223-1533
Mailing Address - Fax:
Practice Address - Street 1:9100 FREDERICKS HALL RD
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-4005
Practice Address - Country:US
Practice Address - Phone:540-223-1533
Practice Address - Fax:540-223-1533
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT61274787172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver