Healthcare Provider Details

I. General information

NPI: 1780820183
Provider Name (Legal Business Name): VANESSA DIANNE HOLLOWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

771 VESPER WAY
CAMANO ISLAND WA
98282-6523
US

V. Phone/Fax

Practice location:
  • Phone: 425-374-3149
  • Fax:
Mailing address:
  • Phone: 360-420-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00135317
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: