Provider Demographics
NPI:1275154320
Name:MALYSH, JENIA ALEXANDRA (DNP, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JENIA
Middle Name:ALEXANDRA
Last Name:MALYSH
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S HORTON ST APT 1018
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:918 S HORTON ST APT 1018
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1513
Practice Address - Country:US
Practice Address - Phone:206-333-8258
Practice Address - Fax:206-649-7182
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61561680363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health