MEDICARE: MS. MELISSA ANN FRY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	257857	NC

General Provider Information

NPI Number	:	1770170276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA ANN FRY RN

Provider Business Mailing Address
First Line	:	16669 COMMONS CREEK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3019
Country	:	US
Telephone Number	:	321-460-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	16669 COMMONS CREEK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3019
Country	:	US
Telephone Number	:	321-460-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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