Provider Demographics
NPI:1679719819
Name:MALLOY, DANA ELAINE (RN-FNP)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:ELAINE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:E
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 SUMMERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7704
Mailing Address - Country:US
Mailing Address - Phone:803-649-5300
Mailing Address - Fax:803-649-0056
Practice Address - Street 1:102 SUMMERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7704
Practice Address - Country:US
Practice Address - Phone:803-649-5300
Practice Address - Fax:803-649-0056
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4057363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
582366418OtherTAX ID