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Individual
KELLY MARIE WAICUS
Active
Individual
KELLY MARIE WAICUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
9801106
NC
2080S0010X
Pediatric Sports Medicine Physician
Primary
9801106
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891184X
—
NC
Enumeration date
07/10/2006
Last updated
08/14/2026
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