Provider Demographics
NPI:1780459784
Name:MALAKOWSKY, LISA MARY (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:MALAKOWSKY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-0674
Mailing Address - Country:US
Mailing Address - Phone:208-304-5202
Mailing Address - Fax:
Practice Address - Street 1:435 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9033
Practice Address - Country:US
Practice Address - Phone:509-935-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61469717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily