Provider Demographics
NPI:1427054089
Name:HOLLOWAY, MICHAEL LAWRENCE (CRNA, NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:CRNA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-6738
Mailing Address - Country:US
Mailing Address - Phone:843-601-2530
Mailing Address - Fax:
Practice Address - Street 1:2719 NEUSE BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2857
Practice Address - Country:US
Practice Address - Phone:843-601-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC989367500000X
GARN178935367500000X
NC5015807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406726600Medicaid
TN1505840Medicaid
GA697111029IMedicaid
MD454MK480Medicare PIN
TN1505840Medicaid
TN3600307Medicare PIN