Healthcare Provider Details

I. General information

NPI: 1134652480
Provider Name (Legal Business Name): CARMELLA HORTON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 NORTHCUTT PL
DAYTON OH
45414-3840
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2020
  • Fax: 937-496-2016
Mailing address:
  • Phone: 937-496-2000
  • Fax: 937-463-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.348868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: