Basic Information
Provider Information
NPI: 1538256011
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STINSON
FirstName: GINA
MiddleName: MORRIS
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 SHIPYARD BLVD
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284126431
CountryCode: US
TelephoneNumber: 9103430145
FaxNumber: 9102029966
Practice Location
Address1: 4005 OLEANDER DR
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284036816
CountryCode: US
TelephoneNumber: 9107909949
FaxNumber: 9102029966
Other Information
ProviderEnumerationDate: 10/06/2006
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-06684NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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