Provider Demographics
NPI:1275006033
Name:PENTON, GAOJUA JULIET
Entity Type:Individual
Prefix:
First Name:GAOJUA
Middle Name:JULIET
Last Name:PENTON
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 1:2153 VALLEYGATE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3667
Mailing Address - Country:US
Mailing Address - Phone:910-260-5216
Mailing Address - Fax:
Practice Address - Street 1:2153 VALLEYGATE DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3667
Practice Address - Country:US
Practice Address - Phone:910-260-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily