Healthcare Provider Details

I. General information

NPI: 1922672427
Provider Name (Legal Business Name): LISA ANN MALONE RN, BSN, CWON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 DAKOTA ST
TORONTO SD
57268-2001
US

IV. Provider business mailing address

840 DAKOTA ST
TORONTO SD
57268-2001
US

V. Phone/Fax

Practice location:
  • Phone: 605-690-7358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberR037495
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR037495
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: