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General NPI Number Information
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NPI Number | 1558651760
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Entity Type | Individual
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Provider Name | MALINDA MAE CARLILE ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2011
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 315 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4234
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Country | US
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Telephone | 253-403-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 315 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4234
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Country | US
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Telephone | 253-403-1109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP60155453
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License Number State | WA
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