Provider Demographics
NPI:1306689278
Name:HOLLOWAY, MACKENZIE PAIGE (ARNP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:PAIGE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MACKENZIE
Other - Middle Name:PAIGE
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:14919 N HEDIN RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9686
Mailing Address - Country:US
Mailing Address - Phone:509-724-9696
Mailing Address - Fax:
Practice Address - Street 1:759 E HOLLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-270-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61575053363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner