Individual
MRS. MEREDITH WAY WAWNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0010-00699
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578638110
—
NC
01
—
196360
MEDCOST PROVIDER NUMBER
NC
05
—
2370PA
—
SC
01
—
2755674
UNITED HEALTHCARE NUMBER
NC
Enumeration date
11/21/2006
Last updated
11/14/2016
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