Provider Demographics
NPI:1649353806
Name:GUNNESON, EUNICE (PA-C)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:GUNNESON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 KIMBALL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1859
Mailing Address - Country:US
Mailing Address - Phone:919-667-7579
Mailing Address - Fax:
Practice Address - Street 1:2797 NC HIGHWAY 55
Practice Address - Street 2:MINUTECLINIC DIAGNOSTIC OF NORTH CAROLINA, P.C.
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2753032Medicare ID - Type Unspecified
P19331Medicare ID - Type Unspecified