Provider Demographics
NPI:1538899232
Name:MALLOY, CASEY (RN)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1545
Mailing Address - Country:US
Mailing Address - Phone:610-816-5728
Mailing Address - Fax:
Practice Address - Street 1:1800 N 12TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1545
Practice Address - Country:US
Practice Address - Phone:610-816-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN689276163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health