Provider Demographics
NPI:1396719530
Name:BLACK, HOLLY HOOD (NPP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:HOOD
Last Name:BLACK
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N ELAM AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1118
Mailing Address - Country:US
Mailing Address - Phone:336-274-1114
Mailing Address - Fax:336-232-5326
Practice Address - Street 1:509 N ELAM AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1118
Practice Address - Country:US
Practice Address - Phone:336-274-1114
Practice Address - Fax:336-232-5326
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ17995Medicare UPIN
NC2592076Medicare ID - Type Unspecified