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General NPI Number Information
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NPI Number | 1366418246
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Entity Type | Organization
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Legal Business Name | WAKEMED
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 535 W GANNON AVE
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City | ZEBULON
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State | NC
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Zip | 27597-2599
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Country | US
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Telephone | 919-350-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 535 W GANNON AVE
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City | ZEBULON
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State | NC
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Zip | 27597-2599
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Country | US
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Telephone | 919-350-4700
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Fax |
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Authorized Official
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Title or Position | SR VP OF FINANCE AND CFO
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Name | MR. MICHAEL D DEVAUGHN
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Credential | CPA
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Telephone | 919-350-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | H0199
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License Number State | NC
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