MALLORY FOSSA

HARTFORD, CT
NPI1780059030
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207LP3000X Anesthesiology, Pediatric Anesthesiology
(Licence: CA  95003548)
Additional Taxonomies363LP0200X Nurse Practitioner, Pediatrics
(Licence: CA  95003548)
363LP0200X Nurse Practitioner, Pediatrics
(Licence: CT  12.008276)
Enumeration Date2015-12-10
Last Update Date2022-09-12
Business Address
MALLORY FOSSA PNP-PC
282 WASHINGTON ST
HARTFORD, CT 06106-3322
Phone number: 860-837-5207
Mailing Address
MALLORY FOSSA PNP-PC
3701 WILSHIRE BLVD SUITE 600
LOS ANGELES, CA 90010-2814
Phone number: 323-361-3550