Provider Demographics
NPI:1588859995
Name:KELLER, MELISSA ROSE (RNC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ROSE
Last Name:KELLER
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:SCHAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC
Mailing Address - Street 1:142 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1710
Mailing Address - Country:US
Mailing Address - Phone:937-416-2295
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-262-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-265987163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health