Provider Demographics
NPI:1285798363
Name:BESECKER, ADRIANE NICHOLE
Entity type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:NICHOLE
Last Name:BESECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STONEMONT CT
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1135
Mailing Address - Country:US
Mailing Address - Phone:937-698-1176
Mailing Address - Fax:937-698-4369
Practice Address - Street 1:205 STONEMONT CT
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1135
Practice Address - Country:US
Practice Address - Phone:937-698-1176
Practice Address - Fax:937-698-4369
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN290327163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582576Medicaid