MEDICARE: SUMMER-SKYY HOLLOWAY LPN

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	164W00000X	Licensed Practical Nurse	256384-1	NY

General Provider Information

NPI Number	:	1689990525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER-SKYY HOLLOWAY LPN

Provider Business Mailing Address
First Line	:	6813 AUTUMN POINT DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3068
Country	:	US
Telephone Number	:	631-796-2427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6813 AUTUMN POINT DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3068
Country	:	US
Telephone Number	:	631-796-2427
Fax Number	:

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/15/2015

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