Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN112644 | GA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN112644 | GA |
NPI | 1013393156 |
---|---|
Provider Name | Mrs. Teresa Hollowell |
First Address | Fort Bragg, NC 28310-7394 |
Second Address | Fort Bragg, NC 28310-6118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 14/04/2020 |