FANTA MALLARD

GARY, IN
NPI1598490013
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy202C00000X Independent Medical Examiner
(Licence: IN  M6S9Q7R7)
Additional Taxonomies170100000X Medical Genetics, Ph.D. Medical Genetics
172A00000X Driver
Enumeration Date2022-07-19
Last Update Date2022-07-19
Business Address
FANTA MALLARD MEDICAL ASSISTANT
578 TENNESSEE ST
GARY, IN 46402-1438
Phone number: 312-241-3044
Mailing Address
FANTA MALLARD MEDICAL ASSISTANT
578 TENNESSEE ST
GARY, IN 46402-1438
Phone number:
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