Provider Demographics
NPI:1528523834
Name:HALLORAN, MATTHEW ANDREW (FNP-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANDREW
Last Name:HALLORAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S MEBANE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6235
Mailing Address - Country:US
Mailing Address - Phone:336-222-0291
Mailing Address - Fax:336-222-0293
Practice Address - Street 1:2501 S MEBANE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6235
Practice Address - Country:US
Practice Address - Phone:336-222-0291
Practice Address - Fax:336-222-0293
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily