Healthcare Provider Details

I. General information

NPI: 1265429948
Provider Name (Legal Business Name): JUDITH ROBINSON MALONEY ANP/GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 REMOUNT RD
GASTONIA NC
28054-7413
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-0600
  • Fax: 704-865-4785
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-867-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: