Individual provider Active NPI

Annelise Barbara Yvonne Landreth, MSN, FNP

  • Family Nurse Practitioner
  • Raleigh, NC
National Provider Identifier
1790476869
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5018604 Issued in NC
Practice address
4530 Fayetteville Rd
Raleigh, NC 27603-3614
Phone
(919) 235-1930
NPI assigned
May 18, 2023
Last updated
Oct 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5018604 NC Primary

Addresses

Primary practice location

4530 Fayetteville Rd
Raleigh, NC 27603-3614

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0351

Other identifiers 1

IdentifierTypeStateIssuer
1790476869MedicaidNC

Other names 1

  • Annelise Rogers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231109003249 NC Practitioner - Nurse Practitioner 8224485461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Marymount University, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Specialty Physicians LLCGroup PAC ID 7416006085, 178 clinicians

Practice addresses (Care Compare)

4530 Fayetteville Rd
Raleigh, NC 27603-3614
Phone (919) 350-0365

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Specialty Physicians, LLC Current Accepting new patients
Wake Specialty Physicians LLC CurrentSince Oct 9, 2023 Accepting new patients
Wake Specialty Physicians LLC CurrentSince Oct 9, 2023 Accepting new patients
Wake Specialty Physicians LLC PastSince Nov 8, 2025 Accepting new patients

Locations

2216 E NC Highway 54
Durham, NC 27713
Phone (919) 544-2020

7021 NC Highway 751
Durham, NC 27707
Phone (919) 235-0365

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

6800 Glenwood Ave
Raleigh, NC 27612
Phone (919) 235-1939

10000 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1630

815 Springfield Commons Dr
Raleigh, NC 27609
Phone (919) 235-1400

4530 Fayetteville Rd
Raleigh, NC 27603
Phone (919) 235-1930

938 N Brightleaf Blvd
Smithfield, NC 27577
Phone (919) 235-1525

2001 S Main St
Wake Forest, NC 27587
Phone (919) 562-3155

1260 N Arendell Ave
Zebulon, NC 27597
Phone (919) 235-1326

Interoperability endpoints

  • Direct secure messaging: arogers113721@directhisp.wakemed.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1790476869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 FAYETTEVILLE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276033614",
            "telephone_number": "919-235-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRETH",
        "first_name": "ANNELISE",
        "middle_name": "BARBARA YVONNE",
        "credential": "MSN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-18",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5018604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790476869",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNELISE",
            "last_name": "ROGERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.