Provider Demographics
NPI:1114291374
Name:GURWELL, LANDY (PA)
Entity Type:Individual
Prefix:
First Name:LANDY
Middle Name:
Last Name:GURWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 N VETERANS BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4456
Mailing Address - Country:US
Mailing Address - Phone:830-773-9449
Mailing Address - Fax:830-757-3142
Practice Address - Street 1:1975 N VETERANS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4456
Practice Address - Country:US
Practice Address - Phone:830-773-9449
Practice Address - Fax:830-757-3142
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant