Healthcare Provider Details

I. General information

NPI: 1396492385
Provider Name (Legal Business Name): ROSEMARY ZELENYAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 300
RALEIGH NC
27607-7514
US

IV. Provider business mailing address

4414 LAKE BOONE TRL STE 300
RALEIGH NC
27607-7514
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5510
  • Fax: 919-781-5053
Mailing address:
  • Phone: 919-781-5510
  • Fax: 919-781-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: