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General NPI Number Information
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NPI Number | 1215604269
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Entity Type | Individual
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Provider Name | CHRISTINE MALCOLM
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 7 MAGAURAN DR STE 3
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4040
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Country | US
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Telephone | 860-684-5438
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MAGAURAN DR STE 3
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4040
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Country | US
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Telephone | 860-684-5438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9865
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 9865
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9865
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 9865
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License Number State | CT
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