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1578218616
MALLORY RAE VANDEVENDER
FLOWOOD, MS
NPI
1578218616
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MS 905114)
Enumeration Date
2022-02-17
Last Update Date
2022-02-17
Business Address
MALLORY RAE VANDEVENDER FNP-C
4290 LAKELAND DR STE A
FLOWOOD, MS 39232-9571
Phone number: 601-932-0083
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Mailing Address
MALLORY RAE VANDEVENDER FNP-C
3000 VOLLEY CAMPBELL RD
TERRY, MS 39170-9057
Phone number: 601-201-0163
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