Provider Demographics
NPI:1922287705
Name:DINSMORE, MELISSA MARIE (RN, CCNS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:DINSMORE
Suffix:
Gender:F
Credentials:RN, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 227
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2584
Mailing Address - Country:US
Mailing Address - Phone:937-667-5994
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-2584
Practice Address - Country:US
Practice Address - Phone:513-705-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09355-NS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056333Medicaid
OHH069020Medicare PIN