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General NPI Number Information
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NPI Number | 1588558449
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Entity Type | Individual
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Provider Name | CRYSTAL ANNE MALONE
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Gender | Female
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 4401 W WESTERN AVE
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City | SOUTH BEND
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State | IN
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Zip | 46619-2600
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Country | US
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Telephone | 674-725-7006
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Fax | 574-807-9614
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Provider Business Mailing Address
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Address Line | 1700 MISHAWAKA AVE
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City | SOUTH BEND
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State | IN
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Zip | 46615-1408
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28248235A
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License Number State | IN
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