Provider Demographics
NPI:1952578775
Name:MALLIOS, JOSEPH LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPH
Middle Name:LYNN
Last Name:MALLIOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JOE
Other - Middle Name:LYNN
Other - Last Name:AYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4724 MARSHALL RD APT F
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5783
Mailing Address - Country:US
Mailing Address - Phone:937-648-7105
Mailing Address - Fax:
Practice Address - Street 1:4724 MARSHALL RD APT F
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5783
Practice Address - Country:US
Practice Address - Phone:937-648-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 123130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse