Provider Demographics
NPI:1609353648
Name:GROESSER, ALLISON KATHLEEN (CPNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KATHLEEN
Last Name:GROESSER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 LAKE BOONE TRL
Mailing Address - Street 2:STE 310
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7510
Mailing Address - Country:US
Mailing Address - Phone:984-215-6514
Mailing Address - Fax:
Practice Address - Street 1:4325 LAKE BOONE TRL
Practice Address - Street 2:STE 310
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7510
Practice Address - Country:US
Practice Address - Phone:984-215-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010771363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics