Provider Demographics
NPI:1346721420
Name:MALOSH, MARY ANN (BS,WHED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:MALOSH
Suffix:
Gender:F
Credentials:BS,WHED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 FENWICK CT
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9210
Mailing Address - Country:US
Mailing Address - Phone:517-253-0777
Mailing Address - Fax:
Practice Address - Street 1:6265 FENWICK CT
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-253-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator