Provider Demographics
NPI:1366468738
Name:GAWEDA, AMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GAWEDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843056
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3056
Mailing Address - Country:US
Mailing Address - Phone:910-878-6700
Mailing Address - Fax:910-878-6708
Practice Address - Street 1:6322 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6700
Practice Address - Fax:910-878-6705
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500015632OtherRAILROAD MEDICARE
NC2599194Medicare PIN
NC500015632OtherRAILROAD MEDICARE