Provider Demographics
NPI:1235575895
Name:MALONE, VERONICA MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:MARY
Last Name:MALONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 HARBOUR VIEW BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3769
Mailing Address - Country:US
Mailing Address - Phone:757-636-9403
Mailing Address - Fax:
Practice Address - Street 1:5849 HARBOUR VIEW BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-337-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily