Provider Demographics
NPI:1427142413
Name:MALLERY, LINDA (LPN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:MALLERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 208
Mailing Address - Street 2:201 MAPLE
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0208
Mailing Address - Country:US
Mailing Address - Phone:360-333-7188
Mailing Address - Fax:
Practice Address - Street 1:20903 70TH AVE WEST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7201
Practice Address - Country:US
Practice Address - Phone:425-672-3333
Practice Address - Fax:425-712-0539
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00022765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse