Provider Information for 1760723134
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Ms. DESIREE DIANNE MALAM
Sex: Female
NPI: 1760723134
Last Updated: 2022-05-17
Certification Date: 2022-05-17
Certification Date: 2022-05-17
Details
| Name | Value | ||||||||
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| NPI | 1760723134 | ||||||||
| Enumeration Date | 2013-03-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 777 RICHLAND, MO 65556-0777 United States Phone: 877-406-2662 | Fax: | ||||||||
| Primary Practice Address | 304 W WASHINGTON AVE RICHLAND, MO 65556-7101 United States Phone: 877-406-2662 | Fax: | ||||||||
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