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General NPI Number Information
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NPI Number | 1184217408
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Entity Type | Individual
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Provider Name | MELISSA BENHAM NP
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Gender | Female
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 630 N MAIN ST
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City | SPRINGBORO
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State | OH
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Zip | 45066-7519
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Country | US
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Telephone | 937-748-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 6770 TIPP ELIZABETH RD
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City | TROY
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State | OH
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Zip | 45373-8665
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Country | US
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Telephone | 216-392-4567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0027922
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License Number State | OH
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