Healthcare Provider Details

I. General information

NPI: 1245316231
Provider Name (Legal Business Name): MARY ANGELA MALONEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH & TED STEVENS WAY
KOTZEBUE AK
99752-0043
US

IV. Provider business mailing address

PO BOX 528
KOTZEBUE AK
99752-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-3321
  • Fax:
Mailing address:
  • Phone: 907-442-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP30005369
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1250
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: