=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811758709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALISSA DANIELLE HOPKINS LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 SENECA AVE STE A
-----------------------------------------------------
City | BYESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43723-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-685-0016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 828 MCKINLEY AVE APT 1
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43725-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-995-0647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 109121
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------