Provider Demographics
NPI:1982274635
Name:MOTLEY, MALISHA (LPN)
Entity Type:Individual
Prefix:
First Name:MALISHA
Middle Name:
Last Name:MOTLEY
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 1:8168 ULP ST
Mailing Address - Street 2:
Mailing Address - City:MASURY
Mailing Address - State:OH
Mailing Address - Zip Code:44438-1234
Mailing Address - Country:US
Mailing Address - Phone:724-813-4984
Mailing Address - Fax:
Practice Address - Street 1:237 E FRONT ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1407
Practice Address - Country:US
Practice Address - Phone:724-813-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.169946.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty