Healthcare Provider Details

I. General information

NPI: 1144155383
Provider Name (Legal Business Name): HAVEN HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 TATE BLVD SE
HICKORY NC
28602-1430
US

IV. Provider business mailing address

106 DOBBS DR
STATESVILLE NC
28625-1942
US

V. Phone/Fax

Practice location:
  • Phone: 704-929-5837
  • Fax:
Mailing address:
  • Phone: 704-929-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BONILLA
Title or Position: OWNER/PROVIDER
Credential: FNP-BC
Phone: 704-929-5837