Individual
MELISSA DIANE RUSTERUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
100 GENEVIEVE CT, PEACHTREE CITY, GA 30269-4868
(770) 486-1818
Mailing address
100 GENEVIEVE CT, PEACHTREE CITY, GA 30269-4868
(770) 486-1818
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN215911
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN215911
STATE LICENSE
GA
Enumeration date
10/12/2017
Last updated
07/21/2022
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