Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 107587 | MO |
NPI | 1013118215 |
---|---|
Provider Name | Michelle L. Maloney |
First Address | Saint Peters, MO 63376-1659 |
Second Address | Saint Peters, MO 63376-1659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 05/02/2021 |