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Individual
MALLORY JACOB WALSH
Active
Individual
MALLORY JACOB WALSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
—
—
363A00000X
Physician Assistant
Primary
1466
NH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/24/2018
Last updated
04/18/2019
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