Healthcare Provider Details

I. General information

NPI: 1619369832
Provider Name (Legal Business Name): LINDA NELL MALENOWSKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97030
US

IV. Provider business mailing address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-6808
  • Fax: 503-666-6835
Mailing address:
  • Phone: 503-666-6808
  • Fax: 503-666-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201405413RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: