Provider Demographics
NPI:1154827913
Name:MALLENDER, JANYNE LANDRA
Entity Type:Individual
Prefix:
First Name:JANYNE
Middle Name:LANDRA
Last Name:MALLENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BOULDER FALLS DR APT C312
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2884
Mailing Address - Country:US
Mailing Address - Phone:503-367-1628
Mailing Address - Fax:
Practice Address - Street 1:300 BOULDER FALLS DR APT C312
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2884
Practice Address - Country:US
Practice Address - Phone:503-367-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA198123OtherDRIVERS LICENSE