Provider Demographics
NPI:1235602939
Name:MEBANE, GWENDOLYN C
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:C
Last Name:MEBANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SWEET GUM WAY
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-6508
Mailing Address - Country:US
Mailing Address - Phone:336-214-1397
Mailing Address - Fax:
Practice Address - Street 1:412 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5934
Practice Address - Country:US
Practice Address - Phone:336-214-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care