Healthcare Provider Details

I. General information

NPI: 1336598952
Provider Name (Legal Business Name): MELISSA JENNINGS LUNSFORD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 06/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD SUITE 300
RALEIGH NC
27607-6478
US

IV. Provider business mailing address

2800 BLUE RIDGE RD SUITE 300
RALEIGH NC
27607-6478
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax:
Mailing address:
  • Phone: 919-784-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251213
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: