Provider Demographics
NPI:1396143178
Name:ANSPAUGH, MALLORY
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:ANSPAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 FINLAND DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2737
Mailing Address - Country:US
Mailing Address - Phone:937-409-6553
Mailing Address - Fax:
Practice Address - Street 1:188 FINLAND DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-2737
Practice Address - Country:US
Practice Address - Phone:937-409-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.149749-M-IV164W00000X
IN27068874A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse