Healthcare Provider Details

I. General information

NPI: 1881201341
Provider Name (Legal Business Name): SHAWNTA MARIE MALAKOWSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD SEWARD HWY STE 300
ANCHORAGE AK
99503-6079
US

IV. Provider business mailing address

2165 E GRIZZLY BEAR DR
WASILLA AK
99654-2721
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax:
Mailing address:
  • Phone: 575-248-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number185626
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: