Provider Demographics
NPI:1922467075
Name:CROSS, MALORIE NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MALORIE
Middle Name:NICOLE
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MALORIE
Other - Middle Name:NICOLE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3712 VALE LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1949
Mailing Address - Country:US
Mailing Address - Phone:434-210-2382
Mailing Address - Fax:
Practice Address - Street 1:3712 VALE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1949
Practice Address - Country:US
Practice Address - Phone:434-210-2382
Practice Address - Fax:215-943-5448
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN719615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse