Provider Demographics
NPI:1740296557
Name:BOATWRIGHT, MELANIE MCNEELY (GNP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MCNEELY
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2593
Mailing Address - Country:US
Mailing Address - Phone:828-550-6278
Mailing Address - Fax:336-540-6156
Practice Address - Street 1:3803 N. ELM ST.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455
Practice Address - Country:US
Practice Address - Phone:828-550-6278
Practice Address - Fax:336-540-6156
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600135363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000434Medicaid
NC7000434Medicaid
NC2807429AMedicare PIN
NCP78124Medicare UPIN