Provider Demographics
NPI:1013118215
Name:MALONEY, MICHELLE L (RN BC-ANP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MALONEY
Suffix:
Gender:F
Credentials:RN BC-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1659
Mailing Address - Country:US
Mailing Address - Phone:636-916-7272
Mailing Address - Fax:636-916-7274
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:STE 100
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:636-916-7272
Practice Address - Fax:636-916-7274
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107587363LA2200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse