Provider Demographics
NPI:1598849028
Name:SCHRECK, GARY J (ANP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:SCHRECK
Suffix:
Gender:M
Credentials:ANP
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Mailing Address - Street 1:1300 BAXTER ST STE 215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3106
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:SUITE F
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-864-8302
Practice Address - Fax:704-864-0228
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0050-02239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592787Medicare PIN