Provider Demographics
NPI:1407980154
Name:MALONE, SUELLEN N (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUELLEN
Middle Name:N
Last Name:MALONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SUELLEN
Other - Middle Name:N
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1019 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1847
Mailing Address - Country:US
Mailing Address - Phone:812-547-6607
Mailing Address - Fax:
Practice Address - Street 1:109 US HIGHWAY 66 E
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2755
Practice Address - Country:US
Practice Address - Phone:812-547-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily