Provider Demographics
NPI:1093763955
Name:GAULDIN, NANCY JOYNER (CNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JOYNER
Last Name:GAULDIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HALIFAX ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6335
Mailing Address - Country:US
Mailing Address - Phone:804-863-1652
Mailing Address - Fax:804-862-6126
Practice Address - Street 1:301 HALIFAX ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-6335
Practice Address - Country:US
Practice Address - Phone:804-863-1652
Practice Address - Fax:804-862-6126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024039011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA046400Medicare UPIN