Provider Demographics
NPI:1619369832
Name:MALENOWSKY, LINDA NELL (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:NELL
Last Name:MALENOWSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NE DIVISION ST SUITE 100
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-666-6808
Mailing Address - Fax:503-666-6835
Practice Address - Street 1:4101 NE DIVISION ST SUITE 100
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-666-6808
Practice Address - Fax:503-666-6835
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405413RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274147Medicaid