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Individual

GINA LEE ENEVOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
600063
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7000915
NC
01
7570650
AETNA
01
B4296
MEDCOST
Enumeration date
11/28/2005
Last updated
05/07/2008
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