Healthcare Provider Details

I. General information

NPI: 1760156897
Provider Name (Legal Business Name): ALLISON HERLONG PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NORTH CHURCH STREET
GREENSBORO NC
27401-2740
US

IV. Provider business mailing address

6300 OAK FOREST CT
SUMMERFIELD NC
27358-9511
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-8064
  • Fax:
Mailing address:
  • Phone: 330-256-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5014684
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number5014684
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: