MEDICARE: BRENDA LEE HOLLOWAY

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	3747P1801X	Personal Care Attendant		OH

General Provider Information

NPI Number	:	1609707629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LEE HOLLOWAY

Provider Business Mailing Address
First Line	:	215 N DALE DR
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-2251
Country	:	US
Telephone Number	:	419-604-7503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 W SPRING ST
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-3249
Country	:	US
Telephone Number	:	419-224-4609
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ BRENDA LEE HOLLOWAY ” Practice Location

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