Healthcare Provider Details

I. General information

NPI: 1770272205
Provider Name (Legal Business Name): ALYSSA ROSE CUNNINGHAM MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5324 MCFARLAND RD STE 300
DURHAM NC
27707-6864
US

IV. Provider business mailing address

204 ROSENBERRY HILLS DR
CARY NC
27513-2781
US

V. Phone/Fax

Practice location:
  • Phone: 919-687-4688
  • Fax: 919-687-4606
Mailing address:
  • Phone: 954-648-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5018040
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: