Provider Demographics
NPI:1578652863
Name:MALANEY, SALLY F (ARNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:F
Last Name:MALANEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 NE BLAKELY DR
Mailing Address - Street 2:SUITE 3020
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6201
Mailing Address - Country:US
Mailing Address - Phone:425-313-7123
Mailing Address - Fax:425-313-7177
Practice Address - Street 1:751 NE BLAKELY DR
Practice Address - Street 2:SUITE 3020
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:425-313-7123
Practice Address - Fax:425-313-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60258143363LA2200X
FLARNP 1864532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG357ZMedicare PIN