Provider Demographics
NPI:1912491168
Name:MALLOY, MAGDALENA AGNIESZKA (APRN)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:AGNIESZKA
Last Name:MALLOY
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 1:3016 W CHARLESTON BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1964
Mailing Address - Country:US
Mailing Address - Phone:702-290-2701
Mailing Address - Fax:
Practice Address - Street 1:3016 W CHARLESTON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1964
Practice Address - Country:US
Practice Address - Phone:702-790-2701
Practice Address - Fax:702-993-4005
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN80646363LP0808X
HIAPRN2443363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health