Healthcare Provider Details

I. General information

NPI: 1164313151
Provider Name (Legal Business Name): JULIE KAY MALKOWSKI RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 N SCOTTSDALE RD STE 163
SCOTTSDALE AZ
85254-3437
US

IV. Provider business mailing address

1302 E HELENA DR
PHOENIX AZ
85022-2077
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-1585
  • Fax:
Mailing address:
  • Phone: 608-516-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN138394
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: