=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194238626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA HOLLOWAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 11/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9100 FREDERICKS HALL RD
-----------------------------------------------------
City | MINERAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23117-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-223-1533
-----------------------------------------------------
Fax | 540-223-1533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9100 FREDERICKS HALL RD
-----------------------------------------------------
City | MINERAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23117-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-223-1533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number | T61274787
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------