MEDICARE: CARMELLA HORTON BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.348868	OH

General Provider Information

NPI Number	:	1134652480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELLA HORTON BSN, RN

Provider Business Mailing Address
First Line	:	600 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1122
Country	:	US
Telephone Number	:	937-496-2000
Fax Number	:	937-463-2958

Provider Business Practice Location Address
First Line	:	4950 NORTHCUTT PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3840
Country	:	US
Telephone Number	:	937-496-2020
Fax Number	:	937-496-2016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	10/09/2020

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