Basic Information
| Provider Information | |||||||||
| NPI: | 1669013777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MESSINO | ||||||||
| FirstName: | MICHELINA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1388 SAND HILL RD | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287158937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282135335 | ||||||||
| FaxNumber: | 8282135336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1388 SAND HILL RD | ||||||||
| Address2: | |||||||||
| City: | CANDLER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287158937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282135335 | ||||||||
| FaxNumber: | 8282135336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2019 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5012057 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | 5012057 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1669013777 | 05 | NC | MEDICAID |