Healthcare Provider Details

I. General information

NPI: 1699694836
Provider Name (Legal Business Name): STEFANY ALEXANDRA SAURA BAENA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SIENA DR STE 130
WAKE FOREST NC
27587-3679
US

IV. Provider business mailing address

1409 BAILEY HILL DR
RALEIGH NC
27614-9704
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-6540
  • Fax:
Mailing address:
  • Phone: 919-649-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: