Provider Demographics
NPI:1811758709
Name:HOPKINS, MALISSA DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:MALISSA
Middle Name:DANIELLE
Last Name:HOPKINS
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 1:828 MCKINLEY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-1519
Mailing Address - Country:US
Mailing Address - Phone:740-995-0647
Mailing Address - Fax:
Practice Address - Street 1:209 SENECA AVE STE A
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-1364
Practice Address - Country:US
Practice Address - Phone:740-685-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse