Provider Demographics
NPI:1891105367
Name:MALNAR, MATTIE LYN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MATTIE
Middle Name:LYN
Last Name:MALNAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W 136TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4434
Mailing Address - Country:US
Mailing Address - Phone:216-471-5013
Mailing Address - Fax:
Practice Address - Street 1:3811 W 136TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4434
Practice Address - Country:US
Practice Address - Phone:216-471-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155380164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse