1497084214 NPI number — NORTH RALEIGH WELLNESS, PLLC

Table of content: (NPI 1497084214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497084214 NPI number — NORTH RALEIGH WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH RALEIGH WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497084214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8414 FALLS OF NEUSE RD
Provider Second Line Business Mailing Address:
SUITE 104A
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-845-0200
Provider Business Mailing Address Fax Number:
919-845-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8414 FALLS OF NEUSE RD
Provider Second Line Business Practice Location Address:
SUITE 104A
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-3544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-845-0200
Provider Business Practice Location Address Fax Number:
919-845-0204
Provider Enumeration Date:
12/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
RONALD
Authorized Official Title or Position:
OWNER/DOCTOR/PRESIDENT
Authorized Official Telephone Number:
919-845-0200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 890834H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com