Healthcare Provider Details

I. General information

NPI: 1629534912
Provider Name (Legal Business Name): NICOLE M MALFI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 BUTTERNUT LN
CLAYTON NC
27520-5857
US

IV. Provider business mailing address

236 BUTTERNUT LN
CLAYTON NC
27520-5857
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-1011
  • Fax: 919-359-9122
Mailing address:
  • Phone: 919-359-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013142
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11676-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: