Provider Demographics
NPI:1265783120
Name:MALONE, MONICA L (APRN, MSN, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:L
Last Name:MALONE
Suffix:
Gender:F
Credentials:APRN, MSN, PMHNP
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:2838 WELLSFORD DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1946
Mailing Address - Country:US
Mailing Address - Phone:218-791-6293
Mailing Address - Fax:
Practice Address - Street 1:2838 WELLSFORD DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1946
Practice Address - Country:US
Practice Address - Phone:218-791-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023198363LP0808X
NCAPRN.CNP.023198363LP0808X
OHAPRN.CNP023198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH023198Medicaid
OH023198Medicaid