Provider Demographics
NPI:1063796977
Name:MALONEY, MARLENE K (RN)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:K
Last Name:MALONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7053 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5403
Mailing Address - Country:US
Mailing Address - Phone:315-453-0272
Mailing Address - Fax:315-453-0275
Practice Address - Street 1:7053 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5403
Practice Address - Country:US
Practice Address - Phone:315-453-0272
Practice Address - Fax:315-453-0275
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222730-1163W00000X
NY222730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse