Provider Demographics
NPI:1699050518
Name:SEALS, MALISHA DODSON (RN)
Entity type:Individual
Prefix:MRS
First Name:MALISHA
Middle Name:DODSON
Last Name:SEALS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 TAZEWELL HWY
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-6847
Mailing Address - Country:US
Mailing Address - Phone:423-300-0006
Mailing Address - Fax:
Practice Address - Street 1:178 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3666
Practice Address - Country:US
Practice Address - Phone:423-733-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000082347163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health