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Anna Tai Malone

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669

PECOS Enrollment

Based on the most recent information from CMS, provider Anna Tai Malone is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1033892237
Provider Type
Individual
Full Name
Malone, Anna Tai
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
8/14/2023
Last Updated
8/29/2024

Contact Information

Practice Location

2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669

(414) 649-7900

Unlisted Fax

Mailing Location

PO Box 735044, Chicago, IL 60673-5044

(414) 649-6000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 14366 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 100253506	Description Medicaid	Issuer Unlisted Wisconsin

Anna Tai Malone

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Buchaklian, Celeste Miranda

Chojnacki, Carl L

Conlin, Adam

Dienberg, Becky

Burns, Jayme

Lauzon, Merissa E

Goedde, Samantha J

Sanders, Heather Kathleen

Fischer, Kay M

Kopatich Pasewald, Kristen A