Provider Demographics
NPI:1215760384
Name:HEALING HYDRATION
Entity type:Organization
Organization Name:HEALING HYDRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, FNP
Authorized Official - Prefix:
Authorized Official - First Name:SHERLENE
Authorized Official - Middle Name:ELANE
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:910-514-2775
Mailing Address - Street 1:620 NC HIGHWAY 42 W STE 207
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5803
Mailing Address - Country:US
Mailing Address - Phone:910-514-2775
Mailing Address - Fax:
Practice Address - Street 1:620 NC HIGHWAY 42 W STE 207
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5803
Practice Address - Country:US
Practice Address - Phone:910-514-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty