Organization
THERAQUE
Active
Other names
Theraque Health
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER WYSOCKI (CHIEF EXECUTIVE OFFICER)
(910) 828-7117
Entity
Organization
Contact information
Practice address
301 GOVERNMENT CENTER DR STE 200, WILMINGTON, NC 28403-1796
(910) 828-7117
(910) 828-7118
Mailing address
301 GOVERNMENT CENTER DR STE 200, WILMINGTON, NC 28403-1796
(910) 828-7117
(910) 828-7118
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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