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NPI Code Detail

MEDICARE: MARIA MALLICK NP

MEDICARE: MARIA MALLICK NP
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
1363LF0000XFamily Nurse PractitionerNPF95014562CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NPF95014562OTHERCANPFN

General Provider Information

NPI Number : 1902471535
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA MALLICK NP
Provider Business Mailing Address
First Line : 11120 NE 33RD PL STE 202
Second Line :
City : BELLEVUE
State : WA
Zip : 98004-1444
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2215 OAKMONT WAY
Second Line :
City : WEST SACRAMENTO
State : CA
Zip : 95691-3022
Country : US
Telephone Number : 916-371-1890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2021
Last Update Date : 05/25/2021

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Directions to “ MARIA MALLICK NP” Practice Location

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