Provider Demographics
NPI:1306227699
Name:MALONE, NICOLE J
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:MALONE
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 1:1850 COLONNADE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1504
Mailing Address - Country:US
Mailing Address - Phone:216-801-2539
Mailing Address - Fax:
Practice Address - Street 1:1850 COLONNADE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1504
Practice Address - Country:US
Practice Address - Phone:216-801-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide