Provider Demographics
NPI:1730582214
Name:MESKE, MICHAEL TODD (MSN, AGPC-NP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:MESKE
Suffix:
Gender:M
Credentials:MSN, AGPC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2388
Mailing Address - Country:US
Mailing Address - Phone:919-668-7246
Mailing Address - Fax:
Practice Address - Street 1:4309 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2388
Practice Address - Country:US
Practice Address - Phone:919-668-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI842-55171100000X
NC5017531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171100000XOther Service ProvidersAcupuncturist