Provider Demographics
NPI:1548317639
Name:CUNNINGHAM, HOLLAND BROWN (CRNA)
Entity type:Individual
Prefix:
First Name:HOLLAND
Middle Name:BROWN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HOLLAND
Other - Middle Name:ELIZABETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0004
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27491367500000X
GARN155538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA550789920OtherTRICARE
GA536151446AMedicaid
GA536151446CMedicaid
GA536151446BMedicaid
SCGAN780Medicaid
GA536151446CMedicaid