Provider Demographics
NPI:1679449060
Name:FAULKNER, GERALINE HOLMAN
Entity type:Individual
Prefix:
First Name:GERALINE
Middle Name:HOLMAN
Last Name:FAULKNER
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 1:311 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5362
Mailing Address - Country:US
Mailing Address - Phone:919-339-5302
Mailing Address - Fax:
Practice Address - Street 1:311 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5362
Practice Address - Country:US
Practice Address - Phone:919-339-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty