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General NPI Number Information
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NPI Number | 1821228529
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Entity Type | Individual
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Provider Name | LYNN E MELLENCAMP CN.10784-NP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 9403 KENWOOD RD SUITE B-100
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City | CINCINNATI
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State | OH
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Zip | 45242-6895
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Country | US
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Telephone | 513-891-8045
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Fax | 513-891-8110
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Provider Business Mailing Address
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Address Line | 6056 TENNYSON DR
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City | WEST CHESTER
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State | OH
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Zip | 45069-6428
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA.10784-NP
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License Number State | OH
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