Provider Demographics
NPI:1285409300
Name:MALLIA, LINDSAY TAYLOR
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:TAYLOR
Last Name:MALLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3922
Mailing Address - Country:US
Mailing Address - Phone:337-739-1286
Mailing Address - Fax:
Practice Address - Street 1:216 KAREN DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3922
Practice Address - Country:US
Practice Address - Phone:337-739-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN145001163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care