Healthcare Provider Details

I. General information

NPI: 1902852528
Provider Name (Legal Business Name): WOMENS HEALTH ALLIANCE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL # 308
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

4414 LAKE BOONE TRAIL # 308
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7450
  • Fax: 919-781-6355
Mailing address:
  • Phone: 919-781-7450
  • Fax: 919-781-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY H GARRETT
Title or Position: DIRECTOR
Credential:
Phone: 919-848-4080