Individual
LUKE MELLISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BOULEVARD, WINSTON SALEM, NC 27157-0001
(540) 250-5513
Mailing address
1834 BRANTLEY ST, WINSTON SALEM, NC 27103-3710
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
6460
NC
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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