Healthcare Provider Details

I. General information

NPI: 1396910659
Provider Name (Legal Business Name): WILMINGTON HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8064 MARKET ST
WILMINGTON NC
28411-9384
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-796-7767
  • Fax: 910-686-7159
Mailing address:
  • Phone: 910-617-6705
  • Fax: 910-431-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number73991
License Number StateNC

VIII. Authorized Official

Name: JEANETTE LOVELESS
Title or Position: CBO DIRECTOR
Credential:
Phone: 910-796-7730