Individual
SHERRY MALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
R18112
ND
163WD0400X
Diabetes Educator Registered Nurse
R18112
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19588
BLUE SHIELD
ND
Enumeration date
08/03/2006
Last updated
08/21/2012
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