Provider Demographics
NPI:1073591806
Name:GILLESPIE, MAUREEN MCLAUGHLIN (CRNA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCLAUGHLIN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWTHORN LN
Mailing Address - Street 2:NOVANT HEALTHCARE SYSTEM
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-0757
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORN LN
Practice Address - Street 2:NOVANT HEALTHCARE PRESBYTERIAN
Practice Address - City:CHANRLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024093125367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008919259Medicaid
VA008919259Medicaid
430048744Medicare ID - Type UnspecifiedRAILROAD