Healthcare Provider Details

I. General information

NPI: 1134065907
Provider Name (Legal Business Name): DEBORAH CANNON HOLLOWAY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13120 E 19TH AVE
AURORA CO
80045-2567
US

IV. Provider business mailing address

13120 E 19TH AVE
AURORA CO
80045-2567
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1654304
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: