Provider Demographics
NPI:1215467527
Name:MALLET, SOPHIA ELIZABETH (FNP-C, ARNP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELIZABETH
Last Name:MALLET
Suffix:
Gender:F
Credentials:FNP-C, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1801 NW MARKET ST STE 403
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3901
Practice Address - Country:US
Practice Address - Phone:206-297-5100
Practice Address - Fax:206-297-5151
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60978913163W00000X
WAAP60978914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215467527Medicaid