Individual
ELISSA BETH DINSMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1045 CHANNINGWAY DR STE A, FAIRBORN, OH 45324-9252
(937) 878-8644
(937) 878-8646
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1310
(937) 522-8068
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024166938
VA
363LF0000X
Family Nurse Practitioner
Primary
COA.11091-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010335779
—
VA
Enumeration date
09/20/2006
Last updated
04/21/2023
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