Mary Leanora Mallernee

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R49684 Issued in NM

Practice address

US Hwy 491 N
Shiprock, NM 87420

Phone

(505) 368-6401

Fax

(505) 368-6431

NPI assigned

Oct 26, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200441600000",
    "number": "1407846801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6401",
            "fax_number": "505-368-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 491 N",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-6401",
            "fax_number": "505-368-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLERNEE",
        "first_name": "MARY",
        "middle_name": "LEANORA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-26",
        "last_updated": "2008-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NM",
            "license": "R49684",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R49684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42979323",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99777533",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "803735",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paula M. Magnuson, MS
• Christine Concettina Maisano, MD
• Akinloye Julius Makanjuola, MD
• Jo Ann Malarchick, RN
• Yumna Bint Malik, CNM
• Nellie J. Malone, RN, BSN, MSN, PHD
• Jennifer Michelle Manning, OTR/L, CHT
• Stephanie L Manning
• Sara Jean Mantick, PHARMD
• Sarah Manuelito, RADIOLOGIC TECHNOLOG

• Family Nurse Practitioner in Shiprock, NM
• Providers in Shiprock, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.