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General NPI Number Information
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NPI Number | 1285844662
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Entity Type | Organization
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Legal Business Name | WELLNESS FAMILY PRACTICE, PA
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 100 RIDGE VIEW DR SUITE 105
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City | CARY
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State | NC
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Zip | 27511-5589
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Country | US
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Telephone | 919-859-7044
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Fax | 919-859-7052
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Provider Business Mailing Address
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Address Line | 100 RIDGE VIEW DR SUITE 105
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City | CARY
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State | NC
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Zip | 27511-5589
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Country | US
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Telephone | 919-859-7044
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Fax | 919-859-7052
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Authorized Official
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Title or Position | DOCTOR
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Name | KATI E DESSAUER
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Credential | MD
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Telephone | 919-859-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32201
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License Number State | NC
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