Provider Demographics
NPI:1144290669
Name:SILER, GWENDOLYN WOODS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:WOODS
Last Name:SILER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3917
Mailing Address - Country:US
Mailing Address - Phone:919-776-7640
Mailing Address - Fax:919-776-2956
Practice Address - Street 1:127 N STEELE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3917
Practice Address - Country:US
Practice Address - Phone:919-776-7640
Practice Address - Fax:919-776-2956
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2331038OtherMEDICARE GROUP
NC5950672Medicaid