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NPI Code Detail

MEDICARE: MS. SANDRA THERESA HARRIS-HOLLOWAY CCP

MEDICARE:  MS. SANDRA THERESA HARRIS-HOLLOWAY  CCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1242T00000XPerfusionistNC

General Provider Information

NPI Number : 1003084419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA THERESA HARRIS-HOLLOWAY CCP
Provider Business Mailing Address
First Line : 2522 CASCADILLA ST
Second Line :
City : DURHAM
State : NC
Zip : 27704-4406
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3000 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4504
Country : US
Telephone Number : 919-681-0250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2008
Last Update Date : 02/19/2008

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Directions to “ MS. SANDRA THERESA HARRIS-HOLLOWAY CCP” Practice Location

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