Provider Demographics
NPI:1861118770
Name:HOLLOWAY, ANITA R
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BARRINGTON HALL DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9537
Mailing Address - Country:US
Mailing Address - Phone:704-232-1881
Mailing Address - Fax:
Practice Address - Street 1:405 BARRINGTON HALL DR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9537
Practice Address - Country:US
Practice Address - Phone:704-232-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF00194376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88-4141812OtherPRIVATE PAY