Provider Demographics
NPI:1487046983
Name:ABDULHAFID, GWEN M (FNP-C)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:M
Last Name:ABDULHAFID
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 1:98 DOCTORS DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-4503
Mailing Address - Country:US
Mailing Address - Phone:828-631-8840
Mailing Address - Fax:828-586-5350
Practice Address - Street 1:98 DOCTORS DR STE 310
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-4503
Practice Address - Country:US
Practice Address - Phone:828-631-8840
Practice Address - Fax:828-586-5350
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily