Provider Demographics
NPI:1386165413
Name:MALOTO, MARIA P (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:P
Last Name:MALOTO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:MARIA ISABEL
Other - Middle Name:P
Other - Last Name:MALOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:640 S WASHINGTON ST STE 370
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6788
Mailing Address - Country:US
Mailing Address - Phone:630-420-9500
Mailing Address - Fax:630-420-9502
Practice Address - Street 1:640 S WASHINGTON ST STE 370
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6788
Practice Address - Country:US
Practice Address - Phone:630-420-9500
Practice Address - Fax:630-420-9502
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041302717163WS0121X
IL209.017081363L00000X
IL277000618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0121XNursing Service ProvidersRegistered NursePlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000OtherNA