Fishburne, Gina M
Fishburne, Gina M is an individual health care provider with primary practice located at 19485 Old Jetton Rd Ste 100 , Cornelius NC 28031-6583. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Fishburne, Gina M can be contacted via phone (704) 384-1775.Contact Information
Primary practice address
19485 Old Jetton Rd Ste 100
Cornelius NC 28031-6583
Phone: (704) 384-1775
Fax: (704) 384-1776
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | NC 102864 | North Carolina |
Profile Details
| NPI number | 1497715742 |
|---|---|
| LBN Legal business name | Fishburne, Gina M |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 23rd, 2006 |
| Last updated | Mar 25th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497715742 | NPPES |
| South Carolina | MEDICAID | 0243PA | |
| South Carolina | Other | D7502 |
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