Provider Demographics
NPI:1942537527
Name:MALONE, DONNA (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-479-5605
Mailing Address - Fax:
Practice Address - Street 1:5800 PARK CENTER CT
Practice Address - Street 2:SUITE C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-0710
Practice Address - Country:US
Practice Address - Phone:419-479-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10897NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3019781Medicaid
OHMANP32911Medicare PIN