Provider Demographics
NPI:1083771703
Name:MELANIE ABFALTER
Entity Type:Organization
Organization Name:MELANIE ABFALTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ABFALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:937-439-2820
Mailing Address - Street 1:2160 BROADBENT WAY
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2529
Mailing Address - Country:US
Mailing Address - Phone:937-439-2820
Mailing Address - Fax:
Practice Address - Street 1:2160 BROADBENT WAY
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2529
Practice Address - Country:US
Practice Address - Phone:937-439-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN222249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN222249OtherREGISTERED NURSE LICENSE
OH0854535OtherINDEPENDENT PROVIDER NUMB