Individual
AMANDA KOCOLOSKI WAKELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4525 CAMERON VALLEY PKWY, CHARLOTTE, NC 28211-4369
(704) 355-5100
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015-00554
NC
207RR0500X
Rheumatology Physician
Primary
2015-00554
NC
Other
Enumeration date
06/12/2012
Last updated
07/19/2024
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