Individual
MELISSA LA RUSSO DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
14214 BALLANTYNE LAKE RD, CHARLOTTE, NC 28277-3372
(704) 667-2600
Mailing address
14214 BALLANTYNE LAKE RD, CHARLOTTE, NC 28277-3372
(704) 667-2600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5001556
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5001556
NC
Other
Enumeration date
06/01/2011
Last updated
08/02/2024
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