Provider Demographics
NPI:1861254294
Name:GAINES, JAWANNA O
Entity type:Individual
Prefix:
First Name:JAWANNA
Middle Name:O
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 GEORGIA OAK LN
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-1467
Mailing Address - Country:US
Mailing Address - Phone:170-472-3201
Mailing Address - Fax:
Practice Address - Street 1:837 GEORGIA OAK LN
Practice Address - Street 2:
Practice Address - City:LANDIS
Practice Address - State:NC
Practice Address - Zip Code:28088-1467
Practice Address - Country:US
Practice Address - Phone:704-918-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula