Provider Demographics
NPI:1124536438
Name:MALIK, STEPHANIE HIRES (CRNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HIRES
Last Name:MALIK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9725
Mailing Address - Country:US
Mailing Address - Phone:215-918-8470
Mailing Address - Fax:215-918-8477
Practice Address - Street 1:2326 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9725
Practice Address - Country:US
Practice Address - Phone:215-918-8470
Practice Address - Fax:215-918-8477
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily