Healthcare Provider Details

I. General information

NPI: 1982273256
Provider Name (Legal Business Name): MICHAELA MALKO MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N MONROE ST
MONROE MI
48162-3113
US

IV. Provider business mailing address

1030 N MONROE ST
MONROE MI
48162-3113
US

V. Phone/Fax

Practice location:
  • Phone: 734-682-3309
  • Fax: 734-682-1488
Mailing address:
  • Phone: 734-682-3309
  • Fax: 734-682-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704312687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: