Healthcare Provider Details

I. General information

NPI: 1518030998
Provider Name (Legal Business Name): PAULA A MALONEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MDG
KADENA AFB OKINAWA
96362
JP

IV. Provider business mailing address

PSC 482 BOX 2874
FPO AP
96362
JP

V. Phone/Fax

Practice location:
  • Phone: 6437160
  • Fax:
Mailing address:
  • Phone: 98-890-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number104896
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: