Healthcare Provider Details

I. General information

NPI: 1043266430
Provider Name (Legal Business Name): ELIZABETH M HOLOMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NEW BERN AVENUE 3RD FLOOR NEONATOLOGY
RALEIGH NC
27610
US

IV. Provider business mailing address

2617 COUNTRYWOOD RD
RALEIGH NC
27615-1222
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8709
  • Fax:
Mailing address:
  • Phone: 919-870-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number107882
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: