Healthcare Provider Details

I. General information

NPI: 1649083304
Provider Name (Legal Business Name): AMANDA LYNN HOLLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

8225 US 264 ALTERNATE
BAILEY NC
27807
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-2883
  • Fax:
Mailing address:
  • Phone: 252-235-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number333568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: