Provider Demographics
NPI:1235567900
Name:MCFADDEN, MALIENA MAE
Entity Type:Individual
Prefix:MS
First Name:MALIENA
Middle Name:MAE
Last Name:MCFADDEN
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 1:2660 CHILI AVE APT 18-9
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4156
Mailing Address - Country:US
Mailing Address - Phone:585-415-1683
Mailing Address - Fax:
Practice Address - Street 1:2660 CHILI AVE APT 18-9
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4156
Practice Address - Country:US
Practice Address - Phone:585-415-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315105164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse