NPI | 1083385637 |
---|---|
Former Name | CAROLINE M MALLON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-027644) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28222151A) |
363LF0000X Nurse Practitioner, Family (Licence: IN 71011547A) | |
Enumeration Date | 2021-09-23 |
Last Update Date | 2023-07-24 |