Healthcare Provider Details

I. General information

NPI: 1255752804
Provider Name (Legal Business Name): MADELEINE ELIZABETH HOLLOWAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELEINE ELIZABETH MULLINGS PA-C

II. Dates (important events)

Enumeration Date: 12/29/2013
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-4200
  • Fax: 254-313-4531
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: