Provider Demographics
NPI:1417121427
Name:GUNTER, JANE (PA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GUNTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3915
Practice Address - Country:US
Practice Address - Phone:980-212-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1926363A00000X
NC0010-01635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417121427Medicaid
SC1592PAMedicaid
KY95002671Medicaid
NC8103103Medicaid
NCNC0356BMedicare PIN
SCSC29737772Medicare PIN
NC8103103Medicaid
NCNC0356GMedicare PIN
NCNC0356DMedicare PIN
NC1417121427Medicaid
NCNC0356HMedicare PIN
KY0711103Medicare PIN
NC2760079Medicare PIN
KY95002671Medicaid
NCNC0356CMedicare PIN