Healthcare Provider Details

I. General information

NPI: 1053541003
Provider Name (Legal Business Name): MELISSA EMILY CYR ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 PERRY RD
APEX NC
27502-7701
US

IV. Provider business mailing address

PO BOX 18563
RALEIGH NC
27619-8563
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-0840
  • Fax: 919-791-0911
Mailing address:
  • Phone: 919-782-1806
  • Fax: 919-791-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN276020
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019531
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: