Provider Demographics
NPI:1518262393
Name:MYERS MALONEY, AILEEN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:MARIE
Last Name:MYERS MALONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 WEBER DR
Mailing Address - Street 2:
Mailing Address - City:MANITOU BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:49253-9749
Mailing Address - Country:US
Mailing Address - Phone:517-252-5282
Mailing Address - Fax:
Practice Address - Street 1:6509 WEBER DR
Practice Address - Street 2:
Practice Address - City:MANITOU BEACH
Practice Address - State:MI
Practice Address - Zip Code:49253-9749
Practice Address - Country:US
Practice Address - Phone:517-252-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse