MEDICARE: SHARA HOLLOWAY RN, DOULA

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	163W00000X	Registered Nurse	179053-30	WI
2	172V00000X	Community Health Worker
3	374J00000X	Doula

General Provider Information

NPI Number	:	1922796002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARA HOLLOWAY RN, DOULA

Provider Business Mailing Address
First Line	:	6650 W STATE ST # 153
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-2827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 W STATE ST # 153
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-2827
Country	:	US
Telephone Number	:	262-297-6964
Fax Number	:

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

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	06/29/2023

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