Organization
SUGAR CREEK MEDICAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU WAKEFIELD NP-C,MSN,RN,BSN,MS (MEMBER)
(715) 661-1652
Entity
Organization
Contact information
Practice address
5104 REAGAN DR STE 3, CHARLOTTE, NC 28206-1392
(715) 661-1652
Mailing address
5104 REAGAN DR STE 3, CHARLOTTE, NC 28206-1392
(715) 661-1652
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
281541
NPI
NC
Enumeration date
05/04/2020
Last updated
05/04/2020
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