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General NPI Number Information
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NPI Number | 1235120700
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Entity Type | Organization
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Legal Business Name | WHAP PA
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1901 S HAWTHORNE RD STE 320
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3921
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Country | US
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Telephone | 336-768-1180
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Fax | 336-768-8053
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Provider Business Mailing Address
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Address Line | 1901 S HAWTHORNE RD STE 320
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3921
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Country | US
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Telephone | 336-768-1180
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Fax | 336-768-8053
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MICHELLE LYNN WALLACE
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Credential |
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Telephone | 336-768-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 15372
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License Number State | NC
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