Provider Demographics
NPI:1407267479
Name:MALAND, TIMOTHY DENNIS (RN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DENNIS
Last Name:MALAND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13511 51ST AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3409
Mailing Address - Country:US
Mailing Address - Phone:253-335-5685
Mailing Address - Fax:
Practice Address - Street 1:19930 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1223
Practice Address - Country:US
Practice Address - Phone:206-363-6947
Practice Address - Fax:206-417-6947
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60401717163W00000X
NY674122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse