Provider Demographics
NPI:1760876221
Name:HORNE, ELIZABETH BLACK
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLACK
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 LONDON CHURCH RD NE
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-8386
Mailing Address - Country:US
Mailing Address - Phone:252-236-5990
Mailing Address - Fax:
Practice Address - Street 1:3939 LONDON CHURCH RD NE
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822-8386
Practice Address - Country:US
Practice Address - Phone:252-236-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker