Healthcare Provider Details

I. General information

NPI: 1306768981
Provider Name (Legal Business Name): PAUL S MALANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 61ST AVE W
WEST FARGO ND
58078-2969
US

IV. Provider business mailing address

961 61ST AVE W
WEST FARGO ND
58078-2969
US

V. Phone/Fax

Practice location:
  • Phone: 651-278-0937
  • Fax:
Mailing address:
  • Phone: 651-278-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: