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General NPI Number Information
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NPI Number | 1255303707
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Entity Type | Individual
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Provider Name | LAURA R WITHORNE-MALONEY CNP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 4400 W 69TH ST STE 500
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City | SIOUX FALLS
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State | SD
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Zip | 57108-8170
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Country | US
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Telephone | 605-322-7580
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Fax | 605-322-7579
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Provider Business Mailing Address
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Address Line | 2400 S MINNESOTA AVE STE 100
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City | SIOUX FALLS
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State | SD
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Zip | 57105-3761
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Country | US
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Telephone | 605-322-7510
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Fax | 605-322-6475
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP000224
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CP000224
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 0224
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License Number State | SD
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