Healthcare Provider Details

I. General information

NPI: 1235575895
Provider Name (Legal Business Name): VERONICA MARY MALONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5849 HARBOUR VIEW BLVD STE 250
SUFFOLK VA
23435
US

IV. Provider business mailing address

5849 HARBOUR VIEW BLVD STE 250
SUFFOLK VA
23435-3769
US

V. Phone/Fax

Practice location:
  • Phone: 757-337-4018
  • Fax:
Mailing address:
  • Phone: 757-636-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: