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General NPI Number Information
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NPI Number | 1487658316
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Entity Type | Individual
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Provider Name | SUSAN MARIE MALLONE-STEAD APRN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 4751 S CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33907-1317
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Country | US
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Telephone | 239-343-9888
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Fax | 239-343-9868
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-9888
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Fax | 239-343-9868
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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 | APRN9395706
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN9395706
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License Number State | FL
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