MEDICARE: MRS. HOLLY HOOD BLACK NPP

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
1	363L00000X	Nurse Practitioner	900420	NC

General Provider Information

NPI Number	:	1396719530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY HOOD BLACK NPP

Provider Business Mailing Address
First Line	:	509 N ELAM AVE
Second Line	:	2ND FLOOR
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1118
Country	:	US
Telephone Number	:	336-274-1114
Fax Number	:	336-232-5326

Provider Business Practice Location Address
First Line	:	509 N ELAM AVE
Second Line	:	2ND FLOOR
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1118
Country	:	US
Telephone Number	:	336-274-1114
Fax Number	:	336-232-5326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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