Individual provider · Type 1 NPI

Nicole M. Mallory, PA

Medical Physician Assistant · Warren, MI

NPI number 1578734844 Active

Practice location

28800 Ryan Rd
Warren, MI 48092-4272

Call (586) 573-6400 Map

Fax (586) 576-1918

Mailing address

1431 Washington Blvd, Apt 1716
Detroit, MI 48226-1732

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X5601003330 (MI)

Medical Physician Assistant: Definition to come...

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About NPI 1578734844

Nicole M. Mallory, PA's National Provider Identifier is 1578734844, issued on Mar 14, 2008. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Warren, MI. The record was last updated on Mar 17, 2008.