Provider Demographics
NPI:1417276197
Name:CLINE, MISTI DAWN
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:DAWN
Last Name:CLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISTI
Other - Middle Name:DAWN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1225 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26142-9615
Mailing Address - Country:US
Mailing Address - Phone:304-834-1618
Mailing Address - Fax:
Practice Address - Street 1:1225 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:DAVISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26142-9615
Practice Address - Country:US
Practice Address - Phone:304-834-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27984164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse