Provider Demographics
NPI:1205166287
Name:MALLICH, RANDE LEE (RN)
Entity type:Individual
Prefix:MR
First Name:RANDE
Middle Name:LEE
Last Name:MALLICH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GASKILL AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3333
Mailing Address - Country:US
Mailing Address - Phone:724-396-9060
Mailing Address - Fax:
Practice Address - Street 1:305 GASKILL AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3333
Practice Address - Country:US
Practice Address - Phone:724-396-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN519097L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse