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NPI Profile for MARY L MALLERNEE in SHIPROCK, NM.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Registered Nurse |
163W00000X |
| NPI # | 1407846801 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 10/26/2005 | |
| Last updated | 01/16/2008 - About 18 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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MARY L MALLERNEE
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MARY L MALLERNEE