Healthcare Provider Details

I. General information

NPI: 1619176401
Provider Name (Legal Business Name): CHRISTINE M. MALONE RN, BSN, MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 WEST COWLES ST.
FAIRBANKS AK
99701-5903
US

IV. Provider business mailing address

1717 W. COWLES ST.
FAIRBANKS AK
99701
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax:
Mailing address:
  • Phone: 907-451-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number26430
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: