Organization
WILMINGTON HEALTH ACCESS FOR TEENS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA VAN DE BOVENKAMP CMA (MEDICAL OFFICE ADMINISTRATOR)
(910) 790-9949
Entity
Organization
Contact information
Practice address
4005 OLEANDER DR, WILMINGTON, NC 28403-6816
(910) 790-9944
(910) 790-9455
Mailing address
4005 OLEANDER DR, WILMINGTON, NC 28403-6816
(910) 790-9944
(910) 790-9455
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0108Q
BCBS
NC
05
—
890108Q
—
NC
Enumeration date
04/24/2006
Last updated
10/27/2010
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