Provider Demographics
NPI:1710568712
Name:MALLAMACI, MEGAN (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MALLAMACI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 E 8TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3433
Mailing Address - Country:US
Mailing Address - Phone:214-223-6362
Mailing Address - Fax:
Practice Address - Street 1:2109 E 8TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3433
Practice Address - Country:US
Practice Address - Phone:214-223-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033629363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care