Healthcare Provider Details

I. General information

NPI: 1184551806
Provider Name (Legal Business Name): MS. NA ' TINA MICHELLE BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 POMPTON CT
DAYTON OH
45405
US

IV. Provider business mailing address

4145 PROMPTON CT
DSYTON OH
45405
US

V. Phone/Fax

Practice location:
  • Phone: 937-305-0570
  • Fax: 937-813-1157
Mailing address:
  • Phone: 937-305-0570
  • Fax: 937-813-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number218409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: