Doctor Name: | MS. TERRY L MALLOY |
NPI Number: | 1245232453 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RCNS MSN |
License Number: | 4704102901 |
Business Practice Address: | 560 Osborn Blvd Sault Sainte Marie, MI - 497831961 |
Business Phone Number: | 9066321800 |
Business Fax Number: | 9066322199 |
Mailing Address: | 560 Osborn Blvd, SAULT SAINTE MARIE |
State: | MI |
Postal Code: | 497831961 |
Phone Number: | 9066321800 |
Fax Number: | 9066322199 |
NPI Enumeration Date: | 06/01/2005 |
NPI Last Update Date: | 08/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704102901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |