Provider Demographics
NPI:1891715322
Name:MALONE, DONNA K (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:MALONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3640 HIGH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-397-6930
Mailing Address - Fax:757-393-4864
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-397-6930
Practice Address - Fax:757-393-4864
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001127302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP98564Medicare UPIN
VA002697O46Medicare ID - Type Unspecified