Healthcare Provider Details

I. General information

NPI: 1083215917
Provider Name (Legal Business Name): STEPHANIE HOLDERMAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 OLEANDER DR STE 112
WILMINGTON NC
28403-4722
US

IV. Provider business mailing address

5710 OLEANDER DR STE 112
WILMINGTON NC
28403-4722
US

V. Phone/Fax

Practice location:
  • Phone: 910-769-1785
  • Fax:
Mailing address:
  • Phone: 910-769-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number231439
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: