Provider Demographics
NPI:1679611321
Name:FRANKENA, DEREK JON (CP,BOCOP)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JON
Last Name:FRANKENA
Suffix:
Gender:M
Credentials:CP,BOCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CABIN CRK
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9566
Mailing Address - Country:US
Mailing Address - Phone:919-358-2128
Mailing Address - Fax:
Practice Address - Street 1:200 TIMBERHILL PL
Practice Address - Street 2:SUITE 203
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1596
Practice Address - Country:US
Practice Address - Phone:919-945-0215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795372Medicaid