Healthcare Provider Details

I. General information

NPI: 1467800649
Provider Name (Legal Business Name): ANN GIELYN SILVA-ABUEG KONZEM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2016
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 N MAIN ST
TARBORO NC
27886-1921
US

IV. Provider business mailing address

1357 HOLLAND RD
GREENVILLE NC
27834-7976
US

V. Phone/Fax

Practice location:
  • Phone: 252-823-7212
  • Fax:
Mailing address:
  • Phone: 951-237-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07588
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: