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Individual
MALLORY LEEANN BROADAWAY
Active
Individual
MALLORY LEEANN BROADAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
A003980
AR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
A003980
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201676758
—
AR
01
—
5PA17
BCBS
AR
Enumeration date
11/08/2013
Last updated
05/03/2021
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