Provider Demographics
NPI:1114511847
Name:MALONEY, KATHLEEN HELEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HELEN
Last Name:MALONEY
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 1:621 FAIRMONT ST APT B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1985
Mailing Address - Country:US
Mailing Address - Phone:952-807-4978
Mailing Address - Fax:
Practice Address - Street 1:621 FAIRMONT ST APT B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1985
Practice Address - Country:US
Practice Address - Phone:952-807-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program