| Doctor Name: | MALLORY RADVANSKY |
| NPI Number: | 1376881607 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CFNP |
| License Number: | SP015019 |
| Business Practice Address: | 1800 Franklin St Toronto, OH - 439641949 |
| Business Phone Number: | 7405373898 |
| Business Fax Number: | 7405373956 |
| Mailing Address: | 380 Summit Ave, Mso Physician Billing STEUBENVILLE |
| State: | OH |
| Postal Code: | 439522667 |
| Phone Number: | 7402837597 |
| Fax Number: | 7402837807 |
| NPI Enumeration Date: | 01/22/2013 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP015019 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |