Healthcare Provider Details

I. General information

NPI: 1801125000
Provider Name (Legal Business Name): SUZANNE ALAYNE GLOVER HOLTON RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 NEWMAN RD
NEW BERN NC
28562-5200
US

IV. Provider business mailing address

970 NEWMAN RD
NEW BERN NC
28562-5200
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-9262
  • Fax: 252-633-4080
Mailing address:
  • Phone: 252-633-9262
  • Fax: 252-633-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number153215
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5004859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: