Healthcare Provider Details

I. General information

NPI: 1235602939
Provider Name (Legal Business Name): MS. GWENDOLYN C MEBANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAPLE AVE
BURLINGTON NC
27215-5934
US

IV. Provider business mailing address

1404 SWEET GUM WAY
MEBANE NC
27302-6508
US

V. Phone/Fax

Practice location:
  • Phone: 336-214-1397
  • Fax:
Mailing address:
  • Phone: 336-214-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: