Individual
GWENDOLYN DENISE GARCIA LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
195 W ILLINOIS AVE, SOUTHERN PINES, NC 28387-5808
(910) 692-2444
Mailing address
195 W ILLINOIS AVE, SOUTHERN PINES, NC 28387-5808
(910) 692-2444
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5006800
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902600
—
NC
Enumeration date
03/17/2014
Last updated
09/16/2021
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