Provider Demographics
NPI:1881684447
Name:GAMEWELL, MARILYN MARTIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MARTIN
Last Name:GAMEWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL AVE.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640
Mailing Address - Country:US
Mailing Address - Phone:336-846-6322
Mailing Address - Fax:336-846-7102
Practice Address - Street 1:310 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00454907Medicare PIN
2599425DMedicare PIN
2599425FMedicare PIN
P23230Medicare UPIN