Healthcare Provider Details

I. General information

NPI: 1518282540
Provider Name (Legal Business Name): MARISSA DOROTHY LYNN ABRAM RN, NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA DOROTHY LYNN STANLEY/LEPORE RN, NPP

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SUNNYBROOK RD
RALEIGH NC
27610-1808
US

IV. Provider business mailing address

10 SUNNYBROOK RD
RALEIGH NC
27610-1808
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number603709-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401367-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020602
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: