Provider Demographics
NPI:1588104780
Name:HOLDAWAY, JENNIFER (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HOLDAWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2813
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2813
Mailing Address - Country:US
Mailing Address - Phone:605-342-4233
Mailing Address - Fax:605-341-3464
Practice Address - Street 1:120 E ADAMS ST STE A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4904
Practice Address - Country:US
Practice Address - Phone:605-342-4233
Practice Address - Fax:605-341-3464
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN R035847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse