Provider Demographics
NPI:1942397559
Name:MALKOFF, JANE ANN
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:MALKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ANN
Other - Last Name:KINSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, CS (ANP)
Mailing Address - Street 1:226 YORKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3867
Mailing Address - Country:US
Mailing Address - Phone:317-979-3700
Mailing Address - Fax:317-774-0074
Practice Address - Street 1:324 W MORRIS ST
Practice Address - Street 2:SUITE 109
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1492
Practice Address - Country:US
Practice Address - Phone:317-859-1090
Practice Address - Fax:317-859-3322
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000189A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health