Vicki Holloway, RN
Individual provider Active NPI Registered Nurse · Gaylord, MI
NPI 1306277199 · NPPES record last updated Dec 5, 2013
Key facts
- NPI
- 1306277199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 4704200576 (MI)
- Practice address
- 800 Livingston Blvd
Suite a
Gaylord, MI 49735-8351 - Phone
- (989) 732-7558
- Fax
- (989) 732-8672
- NPI assigned
- Dec 5, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704200576 | MI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Country Community Mental Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704200576 | MI | Yes |
Addresses
Primary practice location
800 Livingston Blvd
Suite a
Gaylord, MI 49735-8351
Mailing address
800 Livingston Blvd
Suite a
Gaylord, MI 49735-8351
Phone (989) 732-7558
Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.