Healthcare Provider Details

I. General information

NPI: 1215011101
Provider Name (Legal Business Name): MELISSA BURLESON MICOL RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ERWIN RD
DURHAM NC
27710-0001
US

IV. Provider business mailing address

2100 ERWIN RD DUKE UNIVERSITY MEDICAL CENTER - DUMC 2914
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-4467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number300326
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number122397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: