NICOLE M MALLORY PA
NPI 1578734844
Physician Assistant - Medical in Warren, MI
Active since March 14, 2008
About Nicole M Mallory Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NICOLE M MALLORY PA (NPI 1578734844) is an individual medical provider in Warren, Michigan, licensed in Michigan (5601003330) and active in the NPI registry since March 2008.
NPPES Registry Identity
NPI1578734844
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameNICOLE M MALLORYCredential: PA
Location Address28800 RYAN RDWarren, MI 48092-4272
Mailing Address1431 Washington Blvd, Apt 1716Detroit, MI 48226-1732
Phone(586) 573-6400
Fax(586) 576-1918
Sole ProprietorYes
Enumeration DateMarch 14, 2008
Last NPPES UpdateMarch 17, 2008
✔ NPI 1578734844 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in MI · 5601003330
28800 RYAN RD, Warren, MI 48092
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Durable Medical Equipment & Medical Supplies
28800 RYAN RD, STE 110A
WARREN, MI 48092
WARREN, MI 48092
Orthopaedic Surgery (Sports Medicine)
28800 RYAN RD, SUITE 220
WARREN, MI 48092
WARREN, MI 48092
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1578734844, enumerated as an "individual" on March 14, 2008.
The provider is located at 28800 RYAN RD WARREN, MI 48092 and the phone number is (586) 573-6400.
Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.
