Individual
MELISSA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1298 N MAIN ST, FUQUAY VARINA, NC 27526-2615
(919) 590-4099
Mailing address
131 E DAVIE ST APT 530, RALEIGH, NC 27601-3055
(704) 737-8410
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001010618
NC
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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