Provider Demographics
NPI:1750842308
Name:SULLIVAN, MELANIE DUNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DUNN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 PROVIDENCE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8915
Mailing Address - Country:US
Mailing Address - Phone:704-341-9600
Mailing Address - Fax:
Practice Address - Street 1:8045 PROVIDENCE RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8915
Practice Address - Country:US
Practice Address - Phone:704-341-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner