Healthcare Provider Details

I. General information

NPI: 1578652863
Provider Name (Legal Business Name): SALLY F MALANEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR SUITE 3020
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

751 NE BLAKELY DR SUITE 3020
ISSAQUAH WA
98029-6201
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-7123
  • Fax: 425-313-7177
Mailing address:
  • Phone: 425-313-7123
  • Fax: 425-313-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 1864532
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60258143
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: