Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 200462 | OK |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN198112 | GA |
NPI | 1316361835 |
---|---|
Provider Name | Anna Tupko Maloy |
First Address | Lawrenceville, GA 30046-1170 |
Second Address | Gainesville, GA 30501-3715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2014 |
Last Update Date | 14/12/2020 |