Healthcare Provider Details

I. General information

NPI: 1205285368
Provider Name (Legal Business Name): MS. SHARON HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON TAYLOR CRNP

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ROCK SPRINGS RD
CONOWINGO MD
21918-1352
US

IV. Provider business mailing address

PO BOX 99
CONOWINGO MD
21918-0099
US

V. Phone/Fax

Practice location:
  • Phone: 410-378-9696
  • Fax: 410-378-9922
Mailing address:
  • Phone: 410-378-9696
  • Fax: 410-378-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR139283
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: