Provider Demographics
NPI:1487945614
Name:MALONE, ADRIANE MICHELE (ARRT (M), CRT (M))
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:MICHELE
Last Name:MALONE
Suffix:
Gender:F
Credentials:ARRT (M), CRT (M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 TONGASS BLVD
Mailing Address - Street 2:APT. 1-A
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9022
Mailing Address - Country:US
Mailing Address - Phone:907-500-8191
Mailing Address - Fax:
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2562
Practice Address - Country:US
Practice Address - Phone:866-595-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148207/407432471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography