Provider Demographics
NPI:1538947312
Name:GRUENHAGEN, MALACHI (RN)
Entity type:Individual
Prefix:
First Name:MALACHI
Middle Name:
Last Name:GRUENHAGEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:TRAVIS
Other - Last Name:ABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2658 VERA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4577
Mailing Address - Country:US
Mailing Address - Phone:513-388-7157
Mailing Address - Fax:
Practice Address - Street 1:4129 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:OH
Practice Address - Zip Code:45236-2417
Practice Address - Country:US
Practice Address - Phone:513-686-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH393748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH393748OtherRN LICENSE ISSUED BY OHIO BOARD OF NURSING