Healthcare Provider Details

I. General information

NPI: 1518646777
Provider Name (Legal Business Name): MELISSA COLLIERS-RIES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 GLENWAY AVE
CINCINNATI OH
45238-3907
US

IV. Provider business mailing address

706 BISON CREEK DR
INDIANAPOLIS IN
46227-0662
US

V. Phone/Fax

Practice location:
  • Phone: 513-386-9362
  • Fax:
Mailing address:
  • Phone: 513-623-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28299384C
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number520666
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.520666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: