Provider Demographics
NPI:1760496897
Name:BROWN, GAYNELLE M (GONPC)
Entity Type:Individual
Prefix:MS
First Name:GAYNELLE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:GONPC
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:704-982-8112
Mailing Address - Fax:704-982-8097
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:704-982-8112
Practice Address - Fax:704-982-8097
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC065434363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976641Medicaid
NC76641OtherBLUE CROSS BLUE SHIELD
NC76641OtherBLUE CROSS BLUE SHIELD
NC2227656BMedicare ID - Type Unspecified
NC2180751AMedicare PIN