Individual
MALEE BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1004 PARKWAY AVE, ELKHART, IN 46516-9348
(574) 218-7131
Mailing address
22443 STATE ROAD 120, ELKHART, IN 46516-5391
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28211008A
IN
363LF0000X
Family Nurse Practitioner
Primary
71006939A
IN
Other
Enumeration date
01/26/2017
Last updated
03/11/2017
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