Provider Demographics
NPI:1972683274
Name:GUNDERSEN, JAMES PATRICK (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:GUNDERSEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-681-1536
Practice Address - Fax:828-213-7053
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535643363L00000X
NC285099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165560703Medicaid
TX8J1961Medicare PIN
TX310077ZSWDMedicare PIN
TXTXB138717Medicare PIN
TXP00375350OtherRAILROAD MEDICARE
TX8Y0718OtherBLUE CROSS BLUE SHIELD
TXP01030491OtherRR MEDICARE
TX310077YMVQMedicare PIN
TX165560702Medicaid
TX165560704Medicaid