Provider Demographics
NPI:1922672427
Name:MALONE, LISA ANN (RN, BSN, CWON)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:MALONE
Suffix:
Gender:F
Credentials:RN, BSN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:SD
Mailing Address - Zip Code:57268-2001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:840 DAKOTA ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:SD
Practice Address - Zip Code:57268-2001
Practice Address - Country:US
Practice Address - Phone:605-690-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR037495163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Single Specialty