Basic Information
| Provider Information | |||||||||
| NPI: | 1992239529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUICK | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | NELSON | ||||||||
| OtherFirstName: | MELISSA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3170 KETTERING BLVD BLDG B3 | ||||||||
| Address2: | |||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379913100 | ||||||||
| FaxNumber: | 9374014560 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 BUSENBARK RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450679602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139886369 | ||||||||
| FaxNumber: | 5139886369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 35.138383 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.