Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NC |
NPI | 1023096658 |
---|---|
Provider Name | Ms. Susan Holliday |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7000209 | (05) | NC |
P32770 | (02) | NC |