Healthcare Provider Details

I. General information

NPI: 1982038790
Provider Name (Legal Business Name): MELISSA ANN TIBBS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 TWINCREEK DR
CARLISLE OH
45005-4044
US

IV. Provider business mailing address

8850 TWINCREEK DR
CARLISLE OH
45005-4044
US

V. Phone/Fax

Practice location:
  • Phone: 937-701-1306
  • Fax:
Mailing address:
  • Phone: 937-701-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.384935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: