Provider Demographics
NPI:1508996455
Name:DOVENBARGER, MALISSA JEAN
Entity Type:Individual
Prefix:MISS
First Name:MALISSA
Middle Name:JEAN
Last Name:DOVENBARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MALISSA
Other - Middle Name:JEAN
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37384 STATE ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9585
Mailing Address - Country:US
Mailing Address - Phone:740-824-4132
Mailing Address - Fax:
Practice Address - Street 1:37384 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9585
Practice Address - Country:US
Practice Address - Phone:740-824-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2452108Medicaid