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Individual
LISA R MALLORY
Active
Individual
LISA R MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN74140-AGPCNP-BC
WV
363LG0600X
Gerontology Nurse Practitioner
APRN741400AGPCNP-BC
WV
Other
Enumeration date
03/12/2019
Last updated
01/07/2021
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