Healthcare Provider Details

I. General information

NPI: 1104817915
Provider Name (Legal Business Name): MARYKAY MALLINAK LIVINGSTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TALLMAN AVE NW
SEATTLE WA
98107-3932
US

IV. Provider business mailing address

15103 102ND AVE NE
BOTHELL WA
98011-7246
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-2700
  • Fax:
Mailing address:
  • Phone: 425-488-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30003748
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: