Healthcare Provider Details

I. General information

NPI: 1285060459
Provider Name (Legal Business Name): MARY HOLMES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7228 MONCURE PITTSBORO RD
MONCURE NC
27559-9595
US

IV. Provider business mailing address

PO BOX 319
MONCURE NC
27559-0319
US

V. Phone/Fax

Practice location:
  • Phone: 919-542-4991
  • Fax: 919-542-3726
Mailing address:
  • Phone: 919-542-4991
  • Fax: 919-542-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: