Individual
MELISSA A. PATILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
825 FAIRFAX AVE STE 201, NORFOLK, VA 23507-1914
(757) 446-7040
(757) 446-7049
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 446-7040
(757) 446-7049
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001208112
VA
363LG0600X
Gerontology Nurse Practitioner
Primary
0024174616
VA
364SG0600X
Gerontology Clinical Nurse Specialist
0015001015
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376098574
—
NC
05
—
1376098574
—
VA
Enumeration date
08/18/2016
Last updated
11/09/2017
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