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NPI Code Detail

MEDICARE: ABIGAIL MALLE PA-C

MEDICARE: ABIGAIL MALLE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant11625AZ

General Provider Information

NPI Number : 1063238558
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL MALLE PA-C
Provider Business Mailing Address
First Line : PO BOX 860912
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55486-0912
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13400 E SHEA BLVD
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85259-5499
Country : US
Telephone Number : 480-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2024
Last Update Date : 04/08/2026

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