Provider Demographics
NPI:1497077010
Name:HOPSON, MARCHELLE LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARCHELLE
Middle Name:LYNN
Last Name:HOPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 GREENBAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2018
Mailing Address - Country:US
Mailing Address - Phone:937-397-3600
Mailing Address - Fax:937-742-7262
Practice Address - Street 1:1402 BENSON DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4603
Practice Address - Country:US
Practice Address - Phone:937-397-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN124126-M-IV164W00000X
OHRN.414877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3046804Medicaid