Healthcare Provider Details

I. General information

NPI: 1720239247
Provider Name (Legal Business Name): NICOLE CAMERON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 04/17/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ROGERS RD STE 210
WAKE FOREST NC
27587-5745
US

IV. Provider business mailing address

3000 ROGERS RD STE 210
WAKE FOREST NC
27587-5745
US

V. Phone/Fax

Practice location:
  • Phone: 919-385-2120
  • Fax: 919-385-2144
Mailing address:
  • Phone: 919-385-2120
  • Fax: 919-385-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021-01983
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: