Provider Demographics
NPI:1841481983
Name:MALONE, REBECCA SUE (ANP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:MALONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 1ST AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-1549
Mailing Address - Country:US
Mailing Address - Phone:907-766-6300
Mailing Address - Fax:907-766-3643
Practice Address - Street 1:131 1ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-1549
Practice Address - Country:US
Practice Address - Phone:907-766-6300
Practice Address - Fax:907-766-3643
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK381363LF0000X
AK22171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse