| Doctor Name: | RYAN MALLO |
| NPI Number: | 1992094403 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DNP, FNP-C |
| License Number: | 4704259565 |
| Business Practice Address: | 341 E Pleasant Valley Rd Shepherd, MI - 488839534 |
| Business Phone Number: | 6037143017 |
| Business Fax Number: | |
| Mailing Address: | 341 E Pleasant Valley Rd, SHEPHERD |
| State: | MI |
| Postal Code: | 488839534 |
| Phone Number: | 6037143017 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2011 |
| NPI Last Update Date: | 11/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704259565 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |