=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285604421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE L. DODDS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 04/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 536 MIRABEAU ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-981-9444
-----------------------------------------------------
Fax | 937-981-9448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 DUPONT CIR SUITE A
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-576-7700
-----------------------------------------------------
Fax | 513-576-1020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN255122 NP06603
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------