Provider Demographics
NPI:1508273590
Name:PURSLEY, MALLORY LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:LOUISE
Last Name:PURSLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:LOUISE
Other - Last Name:MARKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1608 SOUTH J STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:253-274-7993
Practice Address - Street 1:343 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3156
Practice Address - Country:US
Practice Address - Phone:406-752-1790
Practice Address - Fax:406-756-3529
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-198535363LF0000X
WAAP60485703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8935262Medicare UPIN