Healthcare Provider Details

I. General information

NPI: 1881998904
Provider Name (Legal Business Name): JOEL DAVID MALAK RN, APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LYNNE TRL
OREGON WI
53575-3424
US

IV. Provider business mailing address

333 E CAMPUS MALL SUITE NUMBER 6121
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 920-948-2810
  • Fax:
Mailing address:
  • Phone: 608-262-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number169301-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number16646-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: