Provider Demographics
NPI:1316517717
Name:MAHLKENP
Entity type:Organization
Organization Name:MAHLKENP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:401-821-0787
Mailing Address - Street 1:98 LOCKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2109
Mailing Address - Country:US
Mailing Address - Phone:401-821-0787
Mailing Address - Fax:
Practice Address - Street 1:98 LOCKWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2109
Practice Address - Country:US
Practice Address - Phone:401-821-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty