Healthcare Provider Details

I. General information

NPI: 1205441128
Provider Name (Legal Business Name): KATHLEEN MALONEY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

4875 N ARDMORE AVE
MILWAUKEE WI
53217-6002
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3360
  • Fax: 414-266-3563
Mailing address:
  • Phone: 414-426-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number10348
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: