Provider Demographics
NPI:1588385124
Name:HOLLOWAY, TREVOR ALAN (RN)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALAN
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 W KRISTINA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6717
Mailing Address - Country:US
Mailing Address - Phone:480-206-0537
Mailing Address - Fax:
Practice Address - Street 1:2928 W KRISTINA AVE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6717
Practice Address - Country:US
Practice Address - Phone:480-206-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264167163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency