| NPI | 1457753626 |
|---|---|
| Professional Name | MALLORY JOHANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004112) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2015-06-10 |