Provider Demographics
NPI:1598471492
Name:KUBUANU, GLORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:KUBUANU
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 1:1000 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3420
Mailing Address - Country:US
Mailing Address - Phone:980-581-2448
Mailing Address - Fax:
Practice Address - Street 1:1000 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3420
Practice Address - Country:US
Practice Address - Phone:980-581-2448
Practice Address - Fax:828-499-7001
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine