Basic Information
| Provider Information | |||||||||
| NPI: | 1396292017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUDAS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | AMBER | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROWE | ||||||||
| OtherFirstName: | NANCY | ||||||||
| OtherMiddleName: | AMBER | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 339 NEBO SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | NEBO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287616848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286526326 | ||||||||
| FaxNumber: | 8286525625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2016 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 500891 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 500891 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.