Healthcare Provider Details

I. General information

NPI: 1598574022
Provider Name (Legal Business Name): MARIA DESPRES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SUNNYBROOK RD
RALEIGH NC
27610-1855
US

IV. Provider business mailing address

3601 LONG TOWNSEND AVE
FUQUAY VARINA NC
27526-3226
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-6435
  • Fax: 919-231-0314
Mailing address:
  • Phone: 781-484-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5021534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: