MEDICARE: REGINA VICTORIA MALONEY RN, DNP, CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	20172102	MO

General Provider Information

NPI Number	:	1902315609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA VICTORIA MALONEY RN, DNP, CPNP-PC

Provider Business Mailing Address
First Line	:	851 E 5TH ST STE 300
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3130
Country	:	US
Telephone Number	:	636-390-8555
Fax Number	:	636-390-9444

Provider Business Practice Location Address
First Line	:	851 E 5TH ST STE 300
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3130
Country	:	US
Telephone Number	:	636-390-8555
Fax Number	:	636-390-9444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	01/10/2020

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