Healthcare Provider Details

I. General information

NPI: 1396149753
Provider Name (Legal Business Name): ERIN M. MALLERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 MYRTLE ST
LA CONNER WA
98257
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 360-293-4343
  • Fax: 360-588-1587
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60511982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: