Basic Information
| Provider Information | |||||||||
| NPI: | 1427498328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALY | ||||||||
| FirstName: | ANNIKA | ||||||||
| MiddleName: | GIESBRECHT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD, MPH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GIESBRECHT | ||||||||
| OtherFirstName: | ANNIKA | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 603 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978285124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414264502 | ||||||||
| FaxNumber: | 5414266403 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978285124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414264502 | ||||||||
| FaxNumber: | 5414266403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD178406 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.