Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5006237 | NC |
NPI | 1326486176 |
---|---|
Provider Name | Mrs. Holly Campbell Smith |
First Address | Wilmington, NC 28401-7307 |
Second Address | Wilmington, NC 28401-7307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2013 |
Last Update Date | 13/08/2014 |