Provider Demographics
NPI:1649745100
Name:MCCARTER, MALYNDA LEE (RN)
Entity Type:Individual
Prefix:
First Name:MALYNDA
Middle Name:LEE
Last Name:MCCARTER
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 1:1706 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2347
Mailing Address - Country:US
Mailing Address - Phone:425-259-3484
Mailing Address - Fax:206-737-5057
Practice Address - Street 1:1706 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2347
Practice Address - Country:US
Practice Address - Phone:425-259-3484
Practice Address - Fax:206-737-5057
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129942163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse