Healthcare Provider Details

I. General information

NPI: 1952404816
Provider Name (Legal Business Name): MRS. PAULA FAITH WHITLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 WEST HUDSON BLVD
GASTONIA NC
28052
US

IV. Provider business mailing address

4671 TITMAN RD
GASTONIA NC
28056-8651
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-5036
  • Fax: 704-862-5353
Mailing address:
  • Phone: 704-853-5036
  • Fax: 704-862-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number134360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: