Provider Demographics
NPI:1174768592
Name:MALLOZZI, KAREN DENISE (ARNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DENISE
Last Name:MALLOZZI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:DENISE
Other - Last Name:SILCOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2875
Practice Address - Country:US
Practice Address - Phone:541-451-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1476952363LF0000X
OR201501263NP-PP363LF0000X
IN71004251A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
BF046ZMedicare UPIN