Provider Demographics
NPI:1215443130
Name:MALONEY, ANDREA E (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:MALONEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 4TH ST NW STE C
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6675
Mailing Address - Country:US
Mailing Address - Phone:505-433-3994
Mailing Address - Fax:505-433-2748
Practice Address - Street 1:7103 4TH ST NW STE C
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6675
Practice Address - Country:US
Practice Address - Phone:505-433-3994
Practice Address - Fax:505-433-2748
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP03464363LF0000X
NMCNP-03464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68271077Medicaid