Healthcare Provider Details

I. General information

NPI: 1235993049
Provider Name (Legal Business Name): MALGORZATA MONIKA SIWEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 75TH ST SW
EVERETT WA
98203-6293
US

IV. Provider business mailing address

14008 GRANT CREEK RD
ARLINGTON WA
98223-4326
US

V. Phone/Fax

Practice location:
  • Phone: 425-327-1395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number00148625
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: