Provider Demographics
NPI:1417381195
Name:PROGRESSIVE DIABETES CARE, PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE DIABETES CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:910-491-1727
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:PMB 151
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-491-1727
Mailing Address - Fax:910-835-2155
Practice Address - Street 1:354 WAGONER DR
Practice Address - Street 2:STE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3498
Practice Address - Country:US
Practice Address - Phone:910-491-1727
Practice Address - Fax:910-835-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty