Healthcare Provider Details

I. General information

NPI: 1376733279
Provider Name (Legal Business Name): JULIE M MALONEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 63 BOX 6267
WINSLOW AZ
86047
US

IV. Provider business mailing address

HC 63 BOX 6267
WINSLOW AZ
86047
US

V. Phone/Fax

Practice location:
  • Phone: 928-310-6414
  • Fax:
Mailing address:
  • Phone: 928-310-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4245
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4245
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085002990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: