Healthcare Provider Details

I. General information

NPI: 1700545753
Provider Name (Legal Business Name): ANNETTE LORRAINE GWALTNEY DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 E HUDSON BLVD
GASTONIA NC
28054-1694
US

IV. Provider business mailing address

2226 4TH ST NE
HICKORY NC
28601-1453
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 828-234-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGWAL-J8F9N
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015522
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: