MEDICARE: NANCY ALICE HOLLOWAY RN WHNPBC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	612903	TX

General Provider Information

NPI Number	:	1508850942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ALICE HOLLOWAY RN WHNPBC

Provider Business Mailing Address
First Line	:	7400 FANNIN ST
Second Line	:	SUITE 1050
City	:	HOUSTON
State	:	TX
Zip	:	77054-1920
Country	:	US
Telephone Number	:	713-795-1036
Fax Number	:	713-795-1011

Provider Business Practice Location Address
First Line	:	7400 FANNIN ST
Second Line	:	SUITE 1050
City	:	HOUSTON
State	:	TX
Zip	:	77054-1920
Country	:	US
Telephone Number	:	713-795-1004
Fax Number	:	713-796-9485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/01/2013

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