Provider Demographics
NPI:1598139800
Name:MALANOWSKI, SEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MALANOWSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HILYARD ST STE 620
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8157
Mailing Address - Country:US
Mailing Address - Phone:458-205-6500
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST STE 620
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8157
Practice Address - Country:US
Practice Address - Phone:458-205-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
ORPA197106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program