| NPI | 1366937716 |
|---|---|
| Former Name | MALLORY ANN STAFFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704301141) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI AG06180160) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MI AG06180160) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MI AG06180160) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MI AG06180160) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2019-02-05 |