Provider Demographics
NPI:1134652480
Name:HORTON, CARMELLA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1122
Mailing Address - Country:US
Mailing Address - Phone:937-496-2000
Mailing Address - Fax:937-463-2958
Practice Address - Street 1:4950 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3840
Practice Address - Country:US
Practice Address - Phone:937-496-2020
Practice Address - Fax:937-496-2016
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.348868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse