Provider Demographics
NPI:1366561078
Name:HOLLOWAY, LUANN (NP)
Entity type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:12125 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5001
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE GROUND 2 BLACKWELL MEDICAL TOWER
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-6500
Practice Address - Fax:314-317-0606
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-10-23
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Provider Licenses
StateLicense IDTaxonomies
AL1059055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR80804Medicare UPIN