Provider Demographics
NPI:1952478414
Name:MALLEY, DENISE RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RENEE
Last Name:MALLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 N LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9794
Mailing Address - Country:US
Mailing Address - Phone:989-433-2186
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:FOUST HALL 108
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-1748
Practice Address - Fax:989-774-4335
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703082517164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse