Healthcare Provider Details

I. General information

NPI: 1427292267
Provider Name (Legal Business Name): MARIAN CATHERINE MALONE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/25/2024
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED EMERGENCY MED
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2341
  • Fax: 314-454-4345
Mailing address:
  • Phone: 314-454-2341
  • Fax: 314-454-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001022887
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number2001022887
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: