| Lakeside Wellness Center | |
|
4005 Oleander Dr Wilmington NC 28403-6816 | |
| (910) 772-5552 | |
| (910) 772-5554 |
| Full Name | Lakeside Wellness Center |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 4005 Oleander Dr, Wilmington, North Carolina |
| Authorized Official Name and Position | Maria Van De Bovenkamp (DIRECTOR OF ADMINISTRATION) |
| Authorized Official Contact | 9107909949 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Wellness Center 1805 S 13th St Wilmington NC 28401-6469 Ph: (910) 772-5552 | Lakeside Wellness Center 4005 Oleander Dr Wilmington NC 28403-6816 Ph: (910) 772-5552 |
| NPI Number | 1568561207 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 10/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568561207 | NPI | - | NPPES |
| 8701703 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
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