Provider Demographics
NPI:1508522509
Name:HOLLIDAY, DEANNE LEE (RN)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:LEE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 WYSE FORK RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28526-8839
Mailing Address - Country:US
Mailing Address - Phone:252-523-1065
Mailing Address - Fax:
Practice Address - Street 1:5537 WYSE FORK RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NC
Practice Address - Zip Code:28526-8839
Practice Address - Country:US
Practice Address - Phone:252-523-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC315339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse