Healthcare Provider Details

I. General information

NPI: 1275615585
Provider Name (Legal Business Name): KATHLEEN WARNER MALNOR CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BROADWAY ST
BELLINGHAM WA
98225-3237
US

IV. Provider business mailing address

PO BOX 1213
BELLINGHAM WA
98227-1213
US

V. Phone/Fax

Practice location:
  • Phone: 360-746-9585
  • Fax:
Mailing address:
  • Phone: 360-676-2762
  • Fax: 360-767-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN00105173
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30004144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: