Provider Demographics
NPI:1366914335
Name:MACALUSO, MAILE CHRISTINE
Entity type:Individual
Prefix:
First Name:MAILE
Middle Name:CHRISTINE
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAILE
Other - Middle Name:CHRISTINE
Other - Last Name:NUNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-1750
Mailing Address - Fax:406-327-1960
Practice Address - Street 1:3075 N RESERVE ST STE Q
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1390
Practice Address - Country:US
Practice Address - Phone:406-327-1750
Practice Address - Fax:406-327-1960
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-48315163W00000X
MTNUR-APRN-LIC-242966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse