Provider Demographics
NPI:1205040565
Name:BENSON, MELODY LONA
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LONA
Last Name:BENSON
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 1:2682 COCKRELLS RUN RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8360
Mailing Address - Country:US
Mailing Address - Phone:740-352-4789
Mailing Address - Fax:
Practice Address - Street 1:2682 COCKRELLS RUN RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8360
Practice Address - Country:US
Practice Address - Phone:740-352-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide