Healthcare Provider Details

I. General information

NPI: 1336653567
Provider Name (Legal Business Name): IWONA ANNA GASIOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 OVERLAND DR
GREENWOOD SC
29646-4069
US

IV. Provider business mailing address

9 WALDEN RIDGE DR STE 10
ASHEVILLE NC
28803-8592
US

V. Phone/Fax

Practice location:
  • Phone: 833-365-7246
  • Fax:
Mailing address:
  • Phone: 833-365-7246
  • Fax: 828-348-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001009705
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2898
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberTL2898
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: