Provider Demographics
NPI:1295159168
Name:WAKE FOREST BAPTIST HEALTH
Entity type:Organization
Organization Name:WAKE FOREST BAPTIST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEPENBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:408-656-1364
Mailing Address - Street 1:PO BOX 10467
Mailing Address - Street 2:1200 N. ELM STREET
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-0467
Mailing Address - Country:US
Mailing Address - Phone:336-207-7005
Mailing Address - Fax:336-832-8099
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-207-7005
Practice Address - Fax:336-832-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04842282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-04842OtherNORTH CAROLINA STATE MEDICAL BOARD LICENSE NUMBER