Healthcare Provider Details

I. General information

NPI: 1184294233
Provider Name (Legal Business Name): CHRISTY WIMMER PASCHAL NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

2824 OAKCROFT DR
MATTHEWS NC
28105-4232
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-5000
  • Fax:
Mailing address:
  • Phone: 704-433-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberPENDING
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5014733
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: