MEDICARE: WAKE NEPHROLOGY ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	31375	NC
2	174400000X	Specialist	23576	NC
3	174400000X	Specialist	23533	NC
4	174400000X	Specialist	34410	NC
5	174400000X	Specialist	9500252	NC
6	174400000X	Specialist	200100423	NC
7	174400000X	Specialist	200200682	NC
8	174400000X	Specialist	9800209	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891797049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE NEPHROLOGY ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	3604 BUSH ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7511
Country	:	US
Telephone Number	:	919-876-7807
Fax Number	:	919-876-8823

Provider Business Practice Location Address
First Line	:	3604 BUSH ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7511
Country	:	US
Telephone Number	:	919-876-7807
Fax Number	:	919-876-8823

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. JAMIE KENDRA FRICKE
Credential	:
Telephone Number	:	919-876-7807

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/23/2011

Similar Medicare Providers

1508730342 — SARA ROSE WHITE BCBA
Practice Location Address:

3610 BUSH ST
RALEIGH, NC
27609-7511

Practice Phone: 984-204-1233
Practice Fax:

1447238480 — DR. MICHAEL MONAHAN M.D.
Practice Location Address:

3604 BUSH ST , 2ND FLOOR
RALEIGH, NC
27609-7511

Practice Phone: 919-876-7807
Practice Fax: 919-876-8823

1356320303 — DR. JOSEPH KEITH KEENER M.D.
Practice Location Address:

3604 BUSH ST , 2ND FLOOR
RALEIGH, NC
27609-7511

Practice Phone: 919-876-7807
Practice Fax: 919-876-8823

1891774840 — DR. MARK DAVID ROTHMAN M.D.
Practice Location Address:

3604 BUSH ST , 2ND FLOOR
RALEIGH, NC
27609-7511

Practice Phone: 919-876-7807
Practice Fax: 919-876-8823

1366470791 — MRS. DONNA ANTONIA THEODORE PA-C
Practice Location Address:

3604 BUSH ST
RALEIGH, NC
27609-7511

Practice Phone: 919-876-7807
Practice Fax: 919-876-8823

1780796508 — BIO-MEDICAL APPLICATIONS OF NORTH CAROLINA, INC.
Practice Location Address:

3604 BUSH ST
RALEIGH, NC
27609-7511

Practice Phone: 919-876-7501
Practice Fax: 919-875-1594

Directions to “WAKE NEPHROLOGY ASSOCIATES, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.