Provider Demographics
NPI:1962740365
Name:MALOTT, NOADIAH (NP)
Entity type:Individual
Prefix:MS
First Name:NOADIAH
Middle Name:
Last Name:MALOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10982 HOOSIER RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9587
Mailing Address - Country:US
Mailing Address - Phone:317-554-7983
Mailing Address - Fax:
Practice Address - Street 1:10982 HOOSIER RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9587
Practice Address - Country:US
Practice Address - Phone:317-554-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154618A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care