Provider Demographics
NPI:1477855310
Name:HOLLINGDRAKE, MANDY L (RT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:HOLLINGDRAKE
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700B CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5852
Mailing Address - Country:US
Mailing Address - Phone:252-830-2094
Mailing Address - Fax:252-355-7358
Practice Address - Street 1:700B CROMWELL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5852
Practice Address - Country:US
Practice Address - Phone:252-830-2094
Practice Address - Fax:252-355-7358
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6141227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified