Provider Demographics
NPI:1720215890
Name:MALONEY, CHRISTINE (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6028 CANNON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1802
Mailing Address - Country:US
Mailing Address - Phone:215-520-2446
Mailing Address - Fax:610-828-3543
Practice Address - Street 1:1060 FIRST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1336
Practice Address - Country:US
Practice Address - Phone:610-768-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003968H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103079704Medicaid
PA103079704Medicaid