Healthcare Provider Details

I. General information

NPI: 1124789946
Provider Name (Legal Business Name): ANDREA HOLLOWAY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-2156
US

IV. Provider business mailing address

717 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-2156
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-4838
  • Fax:
Mailing address:
  • Phone: 336-544-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296338
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number296338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: