=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902435332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA SUE MILBOWER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2020
-----------------------------------------------------
Last Update Date | 04/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 COLUMBUS AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45036-1684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-528-3923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 SHOEMAKER DR
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-7788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-309-4682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 381351
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------