Provider Demographics
NPI:1033888615
Name:HOWARD, MAHALA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MAHALA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NE 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3162
Mailing Address - Country:US
Mailing Address - Phone:801-540-9140
Mailing Address - Fax:
Practice Address - Street 1:7700 NE PARKWAY DR STE 300
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6654
Practice Address - Country:US
Practice Address - Phone:801-540-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60658407163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN60658407OtherWASHINGTON BOARD OF NURSING
OR201604005RNOtherOREGON BOARD OF NURSING
NV839604OtherNEVADA BOARD OF NURSING