Individual
MARY E MALONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4315 MEMORIAL DR, BELLEVILLE, IL 62226-5342
(618) 767-7023
Mailing address
4315 MEMORIAL DR, BELLEVILLE, IL 62226-5342
(618) 767-7023
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209023096
IL
363LA2200X
Adult Health Nurse Practitioner
209023096
IL
363LG0600X
Gerontology Nurse Practitioner
AG06200301
IL
Other
Enumeration date
09/12/2020
Last updated
11/08/2021
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