Healthcare Provider Details

I. General information

NPI: 1609526821
Provider Name (Legal Business Name): SUSAN E GELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 MARKET ST STE H
WILMINGTON NC
28411-9444
US

IV. Provider business mailing address

1907 S 17TH ST STE 1
WILMINGTON NC
28401-6680
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax: 910-686-7770
Mailing address:
  • Phone: 910-343-8424
  • Fax: 910-343-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5015979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: