Provider Demographics
NPI:1922887322
Name:MALZONE, MARISA (CNS)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MALZONE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61186 SW BEVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-5013
Mailing Address - Country:US
Mailing Address - Phone:808-342-5901
Mailing Address - Fax:
Practice Address - Street 1:61186 SW BEVERLY WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-5013
Practice Address - Country:US
Practice Address - Phone:808-342-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNS18873133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist