Healthcare Provider Details

I. General information

NPI: 1558775486
Provider Name (Legal Business Name): NICOLE O'MALLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 112TH AVE NE STE 320
BELLEVUE WA
98004-4511
US

IV. Provider business mailing address

1035 116TH AVE NE
BELLEVUE WA
98004-4604
US

V. Phone/Fax

Practice location:
  • Phone: 425-289-3000
  • Fax:
Mailing address:
  • Phone: 425-289-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9408481
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberDR.0066683
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number61470679
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: