| NPI | 1073154787 |
|---|---|
| Former Name | MALLORY B MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 1257) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 113578) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2026-03-24 |