Healthcare Provider Details

I. General information

NPI: 1508097676
Provider Name (Legal Business Name): TAMMYE RAYNOR HOLT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 COMMERCE PL APT F
BURLINGTON NC
27215-5170
US

IV. Provider business mailing address

3105 COMMERCE PL APT F
BURLINGTON NC
27215-5170
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-8316
  • Fax:
Mailing address:
  • Phone: 336-684-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number90728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: