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General NPI Number Information
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NPI Number | 1811296957
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Entity Type | Organization
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Legal Business Name | WAKE HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 2620 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1821
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Country | US
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Telephone | 919-573-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1821
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AND ENROLLMENT SPECIA
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Name | ANGELA SWEENEY
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Credential |
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Telephone | 919-573-8539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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