Holliway, Brondwyn
Holliway, Brondwyn is an sole proprietor health care provider with primary practice located at 3824 Hearne Ave , Shreveport LA 71103-4328. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Holliway, Brondwyn can be contacted via phone (318) 635-8606.Contact Information
Primary practice address
3824 Hearne Ave
Shreveport LA 71103-4328
Phone: (318) 635-8606
Fax: (318) 635-1265
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 021100 | Louisiana |
Profile Details
| NPI number | 1790818359 |
|---|---|
| LBN Legal business name | Holliway, Brondwyn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 13th, 2007 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790818359 | NPPES |
| Louisiana | MEDICAID | 1966207 | |
| Louisiana | Other | 1449423 |
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