Provider Demographics
NPI:1942962956
Name:GAULDEN, VIRGINIA ELIZABETH (CNM)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:GAULDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10905 PROVIDENCE RD W STE 260
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1538
Practice Address - Country:US
Practice Address - Phone:704-542-0744
Practice Address - Fax:704-543-7713
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC25583367A00000X
367A00000X
NC367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife