Provider Demographics
NPI:1174185466
Name:MALONE, LACHELLE ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:LACHELLE
Middle Name:ANTOINETTE
Last Name:MALONE
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 1:9772 DUNRAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-3422
Mailing Address - Country:US
Mailing Address - Phone:513-365-4219
Mailing Address - Fax:
Practice Address - Street 1:9772 DUNRAVEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-3422
Practice Address - Country:US
Practice Address - Phone:513-365-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty