Provider Demographics
NPI:1053437061
Name:MALONE-JONES, ROSE M (CNS)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:MALONE-JONES
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CEDAR BARK TRL UNIT 11
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2584
Mailing Address - Country:US
Mailing Address - Phone:937-751-6742
Mailing Address - Fax:
Practice Address - Street 1:301 W 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3033
Practice Address - Country:US
Practice Address - Phone:937-461-0800
Practice Address - Fax:937-496-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-08913364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3047689Medicaid
OH3047689Medicaid
OHMANS03871Medicare PIN
OHH295661Medicare PIN
OHNS03873Medicare PIN