Healthcare Provider Details

I. General information

NPI: 1053437061
Provider Name (Legal Business Name): ROSE M MALONE-JONES CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 1ST ST SUITE 100
DAYTON OH
45402-3033
US

IV. Provider business mailing address

1550 CEDAR BARK TRL UNIT 11
WEST CARROLLTON OH
45449-2584
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-0800
  • Fax: 937-496-0171
Mailing address:
  • Phone: 937-751-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberNS-08913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: