Provider Demographics
NPI:1487812178
Name:MALONE, PAULA DELORES (CST/RST, SA)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DELORES
Last Name:MALONE
Suffix:
Gender:F
Credentials:CST/RST, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706A RICKARD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1028
Mailing Address - Country:US
Mailing Address - Phone:217-698-4361
Mailing Address - Fax:
Practice Address - Street 1:3002 GILL ST
Practice Address - Street 2:SUITE #3
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3438
Practice Address - Country:US
Practice Address - Phone:309-846-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZC0007X246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant