Provider Demographics
NPI:1417511288
Name:GULMIRE, GWENDOLYN LAWSON
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LAWSON
Last Name:GULMIRE
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 1:111 SABAL LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1089
Mailing Address - Country:US
Mailing Address - Phone:865-323-9994
Mailing Address - Fax:
Practice Address - Street 1:35 BILL FRIES DR BLDG I
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2797
Practice Address - Country:US
Practice Address - Phone:843-342-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily