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General NPI Number Information
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NPI Number | 1477378669
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Entity Type | Organization
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Legal Business Name | NORTH WAKE PEDIATRICS
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 701 EXPOSITION PL STE 202
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City | RALEIGH
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State | NC
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Zip | 27615-3359
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Country | US
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Telephone | 919-848-2167
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Fax | 919-848-2168
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Provider Business Mailing Address
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Address Line | PO BOX 12160
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City | BELFAST
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State | ME
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Zip | 04915-4012
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Country | US
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Telephone | 919-848-2167
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Fax | 919-848-2168
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JANET WOODALL
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Credential |
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Telephone | 336-932-3506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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