MALLORY WEAVER

PEORIA, IL
NPI1376235861
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IL  036179363)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
(Licence:   90200000x)
Enumeration Date2023-05-23
Last Update Date2026-08-21
Business Address
Dr. MALLORY WEAVER DO
815 MAIN ST STE C
PEORIA, IL 61602-1080
Phone number: 309-672-4977
Mailing Address
Dr. MALLORY WEAVER DO
1179 N BLUFF LAKE DR
EAST PEORIA, IL 61611-1281
Phone number: