NPIMap

Organization Active NPI

Wilmington Health Access for Teens

  • Registered Dietitian
  • Wilmington, NC
National Provider Identifier
1790093094
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L003170 Issued in NC
Legal business name
WILMINGTON HEALTH ACCESS FOR TEENS
Practice address
4005 Oleander Dr
Wilmington, NC 28403-6816
Phone
(910) 790-9949
Fax
(910) 790-9455
NPI assigned
Sep 21, 2010
Last updated
Sep 21, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria G Van de Bovenkamp
Title
Director of Administration
Phone
(910) 790-9949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X L003170 NC Primary

Addresses

Primary practice location

4005 Oleander Dr
Wilmington, NC 28403-6816

Mailing address

4005 Oleander Dr
Wilmington, NC 28403-6816
Phone (910) 790-9949

Other identifiers 2

IdentifierTypeStateIssuer
0108QOtherNCBCBS
890108QMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Wilmington Health Access for Teens Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1790093094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON HEALTH ACCESS FOR TEENS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-21",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "VAN DE BOVENKAMP",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "910-790-9949"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L003170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0108Q",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890108Q",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.