Provider Demographics
NPI:1518982420
Name:HOUBEN, GEORGANN HEDY GOSNELL (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:GEORGANN
Middle Name:HEDY GOSNELL
Last Name:HOUBEN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:GEORGANN
Other - Middle Name:HEDY
Other - Last Name:GOSNELL HOUBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-0100
Mailing Address - Fax:336-718-0120
Practice Address - Street 1:1381 WESTGATE CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-718-0100
Practice Address - Fax:336-718-0120
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21262363LF0000X
NC201750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMG0970827OtherDEA - NC
NCMG0970827OtherDEA - NC