Provider Demographics
NPI:1447863170
Name:HOLLOWAY, OLIVIA DULANEY (PA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DULANEY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2044
Mailing Address - Country:US
Mailing Address - Phone:901-507-6600
Mailing Address - Fax:901-507-5877
Practice Address - Street 1:1211 UNION AVE STE 495
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6656
Practice Address - Country:US
Practice Address - Phone:901-507-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant