Provider Demographics
NPI:1053313189
Name:MALLIARAKIS, KATHLEEN ANNE (RN, CNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:MALLIARAKIS
Suffix:
Gender:F
Credentials:RN, CNP
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Mailing Address - Street 1:3925 N ABINGDON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2919
Mailing Address - Country:US
Mailing Address - Phone:703-237-7303
Mailing Address - Fax:703-237-7304
Practice Address - Street 1:3925 N ABINGDON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-2919
Practice Address - Country:US
Practice Address - Phone:703-237-7303
Practice Address - Fax:703-237-7304
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024138992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health