Provider Demographics
NPI:1598117079
Name:BROSAN, VANESSA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:BROSAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NC HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9319
Mailing Address - Country:US
Mailing Address - Phone:919-279-8316
Mailing Address - Fax:919-365-7215
Practice Address - Street 1:2600 NC HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9319
Practice Address - Country:US
Practice Address - Phone:919-279-8316
Practice Address - Fax:919-365-7215
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF1114266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily