Healthcare Provider Details

I. General information

NPI: 1790615201
Provider Name (Legal Business Name): OLIVE TREE WEIGHT LOSS AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SALEM TOWNE CT
APEX NC
27502-2311
US

IV. Provider business mailing address

130 SALEM TOWNE CT
APEX NC
27502-2311
US

V. Phone/Fax

Practice location:
  • Phone: 919-299-1825
  • Fax: 949-864-3117
Mailing address:
  • Phone: 919-299-1825
  • Fax: 949-864-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MERLI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 252-702-6782