Gwendolyn Abe De Leon
Individual provider Active NPI Rehabilitation Registered Nurse · La Fayette, GA
NPI 1083405773 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1083405773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Registered Nurse 163WR0400X
- License
- 615507 (NY)
- Practice address
- 205 Roadrunner Blvd
La Fayette, GA 30728-2161 - Phone
- (706) 638-4664
- NPI assigned
- May 13, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 615507 | NY | MD | Rehabilitation Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Registered Nurse | 163WR0400X | 615507 | NY | Yes |
Addresses
Primary practice location
205 Roadrunner Blvd
La Fayette, GA 30728-2161
Mailing address
7204 Fairbanks Rd
Hixson, TN 37343-2409
Other providers in La Fayette, GA
- Abdul Chowdhury
- Clark Health Services LLC
- Leila Clark
- Consistent Care Family Practice
- Countryside Hospice Care Inc
- Amanda Francis Deal
- Jimmie Denson
- Dialysis Clinic Inc.
- Courtney Durham
- Shelby Leigh Eaton
All providers in La Fayette, GA · Rehabilitation Registered Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.