Provider Demographics
NPI:1629534912
Name:MALFI, NICOLE M (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:MALFI
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:W6981 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8034
Mailing Address - Country:US
Mailing Address - Phone:920-882-2400
Mailing Address - Fax:
Practice Address - Street 1:W6981 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-8034
Practice Address - Country:US
Practice Address - Phone:920-882-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013142363L00000X
WI11676-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11676-33OtherAPNP LICENSE
WI100192432Medicaid
WI264174-30OtherRN LICENSE