| NPI | 1578991121 |
|---|---|
| Former Name | NICOLE MALLORY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-006904) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2023-07-13 |