Healthcare Provider Details

I. General information

NPI: 1164352936
Provider Name (Legal Business Name): MELISSA MISENHIMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 KRASNER DR
BROWNSBURG IN
46112-5680
US

IV. Provider business mailing address

2626 KRASNER DR
BROWNSBURG IN
46112-5680
US

V. Phone/Fax

Practice location:
  • Phone: 765-714-5966
  • Fax:
Mailing address:
  • Phone: 765-714-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28190933C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: