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General NPI Number Information
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NPI Number | 1235602939
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Entity Type | Individual
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Provider Name | MS. GWENDOLYN C MEBANE
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Gender | Female
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 412 MAPLE AVE
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City | BURLINGTON
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State | NC
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Zip | 27215-5934
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Country | US
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Telephone | 336-214-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 SWEET GUM WAY
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City | MEBANE
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State | NC
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Zip | 27302-6508
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Country | US
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Telephone | 336-214-1397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | NC
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