Provider Demographics
NPI:1538364583
Name:GDOVIC, KELLY MAUREEN (WHNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MAUREEN
Last Name:GDOVIC
Suffix:
Gender:F
Credentials:WHNP
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Mailing Address - Street 1:11842 ROCK LANDING DR STE 115
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4437
Mailing Address - Country:US
Mailing Address - Phone:757-595-9905
Mailing Address - Fax:757-595-5377
Practice Address - Street 1:11842 ROCK LANDING DR STE 115
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4437
Practice Address - Country:US
Practice Address - Phone:757-595-9905
Practice Address - Fax:757-595-5377
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2013-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024116360363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024116360OtherLICENSE