Individual
MR. NICHOLAS HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1801 W 40TH AVE, SUITE 2B, PINE BLUFF, AR 71603-6940
(870) 535-7457
(870) 535-2522
Mailing address
PO BOX 1272, PINE BLUFF, AR 71613-1272
(870) 535-7457
(870) 535-2522
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C003090
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209579001
—
AR
01
—
5AR79
BCBS
AR
01
—
P01502904
RR MEDICARE
AR
Enumeration date
06/08/2015
Last updated
09/30/2015
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