Individual provider · Type 1 NPI
Sandra Lynne Mallisham, FPMHNP-BC
Psychiatric/Mental Health Nurse Practitioner · San Antonio, TX
NPI number
1053683102
Active
Practice location
2040 Babcock Rd, Suite 403
San Antonio, TX 78229-4425
Fax (210) 858-9990
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 700915 (TX) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1053683102
Sandra Lynne Mallisham, FPMHNP-BC's National Provider Identifier is 1053683102, issued on Feb 6, 2012. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in San Antonio, TX. The record was last updated on Feb 6, 2012.