| NPI | 1144306549 | 
|---|---|
| Former Name | JORDAN E MALLOY | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60904961)  | 
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: ID NP729A)  | 
| Enumeration Date | 2006-10-27 | 
| Last Update Date | 2025-03-04 |