Provider Demographics
NPI:1750143038
Name:HAYBURN, MALAKI
Entity type:Individual
Prefix:
First Name:MALAKI
Middle Name:
Last Name:HAYBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 OWL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:OH
Mailing Address - Zip Code:45628-9738
Mailing Address - Country:US
Mailing Address - Phone:740-656-4102
Mailing Address - Fax:
Practice Address - Street 1:3242 OWL CREEK RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:OH
Practice Address - Zip Code:45628-9738
Practice Address - Country:US
Practice Address - Phone:740-656-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker