Provider Demographics
NPI:1447761804
Name:NZEWUNWAH, RODALYN GONZALEZ (PA-C)
Entity Type:Individual
Prefix:
First Name:RODALYN
Middle Name:GONZALEZ
Last Name:NZEWUNWAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 MOSS GROVE XING
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6422
Mailing Address - Country:US
Mailing Address - Phone:917-693-0114
Mailing Address - Fax:
Practice Address - Street 1:512 WAUGHTOWN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2236
Practice Address - Country:US
Practice Address - Phone:133-679-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001007624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical