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General NPI Number Information
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NPI Number | 1952119125
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Entity Type | Individual
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Provider Name | ANDREA SHAKO WEMBA FNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 2544 COURT DR STE G
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City | GASTONIA
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State | NC
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Zip | 28054-3450
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Country | US
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Telephone | 704-854-9990
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Fax | 704-854-9045
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone | 704-834-2450
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Fax | 704-671-5331
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5021376
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License Number State | NC
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