Doctor Name: | AMANDA MALONE |
NPI Number: | 1033537428 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, FNP-BC |
License Number: | 18573 |
Business Practice Address: | 500 Love St Erwin, TN - 376501734 |
Business Phone Number: | 4237354160 |
Business Fax Number: | 4237354159 |
Mailing Address: | 500 Love St, ERWIN |
State: | TN |
Postal Code: | 376501734 |
Phone Number: | 4237354160 |
Fax Number: | 4237354159 |
NPI Enumeration Date: | 04/02/2014 |
NPI Last Update Date: | 04/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18573 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |