1063379287 NPI number — MARIANNE ELIZABETH HOLLINGSHEAD LPN

Table of content: MARIANNE ELIZABETH HOLLINGSHEAD LPN (NPI 1063379287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063379287 NPI number — MARIANNE ELIZABETH HOLLINGSHEAD LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLINGSHEAD
Provider First Name:
MARIANNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAHAM
Provider Other First Name:
MARIANNE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063379287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 COMMONS DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-333-0622
Provider Business Mailing Address Fax Number:
910-333-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 COMMONS DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-0227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-333-0622
Provider Business Practice Location Address Fax Number:
910-333-0604
Provider Enumeration Date:
01/08/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  HOLL-XQG3D , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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