Healthcare Provider Details

I. General information

NPI: 1588157606
Provider Name (Legal Business Name): MELISSA DAWN DEATON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 4330
COLUMBUS OH
43214
US

IV. Provider business mailing address

3525 OLENTANGY RIVER RD STE 4330
COLUMBUS OH
43214-3937
US

V. Phone/Fax

Practice location:
  • Phone: 614-255-6900
  • Fax: 614-255-6901
Mailing address:
  • Phone: 614-255-6900
  • Fax: 614-255-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.384618
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.023244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: