Provider Demographics
NPI:1093946550
Name:GEDDIES, GWENDOLYN (RN, C)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:GEDDIES
Suffix:
Gender:F
Credentials:RN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 HUNGRYNECK BLVD
Mailing Address - Street 2:SUITE C-364
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3484
Mailing Address - Country:US
Mailing Address - Phone:843-388-9990
Mailing Address - Fax:843-388-0349
Practice Address - Street 1:1150 HUNGRYNECK BLVD
Practice Address - Street 2:SUITE C-364
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3484
Practice Address - Country:US
Practice Address - Phone:843-388-9990
Practice Address - Fax:843-388-0349
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse