Provider Demographics
NPI:1790994697
Name:MALO-CLINES, CHERYL L (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MALO-CLINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:MALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 6579
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0285
Mailing Address - Country:US
Mailing Address - Phone:541-412-8898
Mailing Address - Fax:
Practice Address - Street 1:446 OAK ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9612
Practice Address - Country:US
Practice Address - Phone:541-412-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14753363L00000X
NV00494363L00000X
OR200950082NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner