Healthcare Provider Details

I. General information

NPI: 1417888025
Provider Name (Legal Business Name): HOLLOWAY NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33413 RUSTY CT
WINCHESTER CA
92596-1736
US

IV. Provider business mailing address

33413 RUSTY CT
WINCHESTER CA
92596-1736
US

V. Phone/Fax

Practice location:
  • Phone: 951-764-0385
  • Fax:
Mailing address:
  • Phone: 951-764-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CALLIE HOLLOWAY
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 951-764-0385