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General NPI Number Information
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NPI Number | 1720402142
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Entity Type | Individual
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Provider Name | SUSAN MALATESTA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 8717 DIMOND D CIR
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City | ANCHORAGE
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State | AK
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Zip | 99515-1931
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Country | US
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Telephone | 907-771-0536
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 E MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98112-3806
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Country | US
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Telephone | 62-420-5499
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61016252
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 216470
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 216470
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61016252
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License Number State | WA
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