Provider Demographics
NPI:1598587693
Name:WAVERKA, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WAVERKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 ARROWHEAD BLVD
Mailing Address - Street 2:STE 270
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3940 ARROWHEAD BLVD
Practice Address - Street 2:STE 270
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302
Practice Address - Country:US
Practice Address - Phone:919-563-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021097363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics