Healthcare Provider Details

I. General information

NPI: 1346330362
Provider Name (Legal Business Name): MAYSIL M MALARD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 7TH ST
BISMARCK ND
58501-4436
US

IV. Provider business mailing address

PO BOX 5501
BISMARCK ND
58506-5501
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6000
  • Fax: 701-323-5709
Mailing address:
  • Phone: 701-323-6000
  • Fax: 701-323-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberR11761
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: