Provider Demographics
NPI:1598284564
Name:HOLLOWAY, YONDA LASHUNTA (STNA)
Entity type:Individual
Prefix:
First Name:YONDA
Middle Name:LASHUNTA
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5479 CHATFORD SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7011
Mailing Address - Country:US
Mailing Address - Phone:614-762-0779
Mailing Address - Fax:
Practice Address - Street 1:5479 CHATFORD SQ
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7011
Practice Address - Country:US
Practice Address - Phone:614-762-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401027560110376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid