Provider Demographics
NPI:1578638110
Name:WAWNER, MEREDITH WAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:WAY
Last Name:WAWNER
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 1:1600 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5524
Mailing Address - Country:US
Mailing Address - Phone:910-277-9164
Mailing Address - Fax:910-277-9189
Practice Address - Street 1:1600 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5524
Practice Address - Country:US
Practice Address - Phone:910-277-9164
Practice Address - Fax:910-277-9189
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00699363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC196360OtherMEDCOST PROVIDER NUMBER
NC1578638110Medicaid
SC2370PAMedicaid
NC2755674OtherUNITED HEALTHCARE NUMBER
NCNCP396BMedicare PIN
NC2755674OtherUNITED HEALTHCARE NUMBER
NC1578638110Medicaid
NC2767958Medicare PIN