Individual
MELISSA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8800 N TRYON ST, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28262-3300
(704) 863-5664
(704) 863-5848
Mailing address
PO BOX 560727, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28256-0727
(704) 863-5664
(704) 863-5848
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
048241
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051256
—
NC
05
—
NAN649
—
SC
Enumeration date
06/14/2006
Last updated
08/12/2010
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