Healthcare Provider Details

I. General information

NPI: 1467449710
Provider Name (Legal Business Name): MICHELLE M MALLOY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE WHITE

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 9TH AVE
BELLE PLAINE IA
52208-2200
US

IV. Provider business mailing address

105 9TH AVE
BELLE PLAINE IA
52208-2200
US

V. Phone/Fax

Practice location:
  • Phone: 319-444-3210
  • Fax: 319-444-4099
Mailing address:
  • Phone: 319-444-3210
  • Fax: 319-444-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC087828
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC087828
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: