Provider Demographics
NPI:1275615585
Name:MALNOR, KATHLEEN WARNER (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WARNER
Last Name:MALNOR
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-1213
Mailing Address - Country:US
Mailing Address - Phone:360-676-2762
Mailing Address - Fax:360-767-2762
Practice Address - Street 1:1907 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3237
Practice Address - Country:US
Practice Address - Phone:360-746-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00105173163WW0101X
WAAP30004144363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9619305Medicaid
P89255Medicare UPIN