Individual
BRENT HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1301 E 17TH ST, IDAHO FALLS, ID 83404-6273
(208) 538-3122
Mailing address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/10/2020
Last updated
04/10/2020
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