Individual
MARY MELYSSA MORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-3069
Mailing address
2880 ATWOOD RD, WINSTON-SALEM, NC 27103-5473
(336) 765-5773
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
170177
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051380
—
NC
Enumeration date
11/23/2005
Last updated
08/30/2007
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