Provider Demographics
NPI:1083380075
Name:HATFIELD, MALISSA D
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:D
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 INTERSTATE WIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:WV
Mailing Address - Zip Code:24839
Mailing Address - Country:US
Mailing Address - Phone:304-664-9506
Mailing Address - Fax:
Practice Address - Street 1:1476 INTERSTATE WIGHWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:WV
Practice Address - Zip Code:24839
Practice Address - Country:US
Practice Address - Phone:304-664-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker