Provider Demographics
NPI:1508002213
Name:GWYNN, CHRISTY L
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:L
Last Name:GWYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTY
Other - Middle Name:L
Other - Last Name:GWYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADM
Mailing Address - Street 1:PO BOX 2361
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-2361
Mailing Address - Country:US
Mailing Address - Phone:336-327-6284
Mailing Address - Fax:336-349-4531
Practice Address - Street 1:116 GWYNN DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8710
Practice Address - Country:US
Practice Address - Phone:336-327-6284
Practice Address - Fax:336-349-4531
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-079-070310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility