Organization
COASTAL PEDIATRIC CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY W WALLACE RN, MSN, PNP (OWNER)
(252) 247-5212
Entity
Organization
Contact information
Practice address
212 N 35TH ST, MOREHEAD CITY, NC 28557-3104
(252) 247-5212
(252) 247-1034
Mailing address
212 N 35TH ST, MOREHEAD CITY, NC 28557-3104
(252) 247-5212
(252) 247-1034
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000101
—
NC
Enumeration date
09/29/2005
Last updated
08/22/2020
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