Healthcare Provider Details

I. General information

NPI: 1316555311
Provider Name (Legal Business Name): GLORIA LASHANDA ATAVTI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 41ST ST
WILMINGTON NC
28403-5502
US

IV. Provider business mailing address

PO BOX 1596
SPRING HOPE NC
27882-1596
US

V. Phone/Fax

Practice location:
  • Phone: 910-836-1004
  • Fax:
Mailing address:
  • Phone: 252-458-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013343
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013343
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: