Healthcare Provider Details

I. General information

NPI: 1700230240
Provider Name (Legal Business Name): MALLORY ROGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY GURECKI

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9317 244TH ST SW APT P104
EDMONDS WA
98020-6576
US

IV. Provider business mailing address

9317 244TH ST SW APT P104
EDMONDS WA
98020-6576
US

V. Phone/Fax

Practice location:
  • Phone: 936-349-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.61361654
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: