Provider Demographics
NPI:1427310135
Name:BENNETT, MELISSA SUE (MS, RN, GCNS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, RN, GCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 S ALPHA BELLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SUGARCRK TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45305-9707
Mailing Address - Country:US
Mailing Address - Phone:937-426-2744
Mailing Address - Fax:
Practice Address - Street 1:9050 CENTRE POINTE DR STE 400
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4875
Practice Address - Country:US
Practice Address - Phone:513-603-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-09639364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology