Basic Information
| Provider Information | |||||||||
| NPI: | 1851982029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALECEK | ||||||||
| FirstName: | ANGELIQUE | ||||||||
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| Credential: | AGACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR STE 2300 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237113 | ||||||||
| FaxNumber: | 3026230394 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD STE 2E99 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027335982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2021 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | LP-0010373 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.