MEDICARE: STEPHANIE HOLLOMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704320233	MI

General Provider Information

NPI Number	:	1316825730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HOLLOMAN

Provider Business Mailing Address
First Line	:	4024 KENT RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-1847
Country	:	US
Telephone Number	:	248-342-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	4024 KENT RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-1847
Country	:	US
Telephone Number	:	248-342-2911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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Directions to “ STEPHANIE HOLLOMAN ” Practice Location

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