Provider Demographics
NPI:1972963858
Name:MALONE, ANGELA DOROTHY (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DOROTHY
Last Name:MALONE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DOROTHY
Other - Last Name:BROTHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42456 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1119
Mailing Address - Country:US
Mailing Address - Phone:313-308-6156
Mailing Address - Fax:
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner