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General NPI Number Information
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NPI Number | 1417381195
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE DIABETES CARE, PLLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 354 WAGONER DR STE 101
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3498
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Country | US
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Telephone | 910-491-1727
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Fax | 910-835-2155
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Provider Business Mailing Address
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Address Line | 439 WESTWOOD SHOPPING CTR PMB 151
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1532
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Country | US
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Telephone | 910-491-1727
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Fax | 910-835-2155
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Authorized Official
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Title or Position | OWNER/FAMILY NURSE PRACTITIONER
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Name | MRS. MELISSA B DOYLE
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Credential | FNP-BC
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Telephone | 910-491-1727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5003013
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License Number State | NC
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