Provider Demographics
NPI:1255712089
Name:WARNING, MALLORY JANE
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:JANE
Last Name:WARNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW TRINITY PL
Mailing Address - Street 2:APT 402
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1969
Mailing Address - Country:US
Mailing Address - Phone:618-210-7366
Mailing Address - Fax:
Practice Address - Street 1:120 NW TRINITY PL
Practice Address - Street 2:APT 402
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1969
Practice Address - Country:US
Practice Address - Phone:618-210-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula