Individual
MRS. AUTUMN NICOLE MALLIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
145 HOSPITAL AVE STE 300, DU BOIS, PA 15801-1465
(814) 375-2040
(814) 375-2045
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-4200
(814) 375-4232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA065595
PA
363AS0400X
Surgical Physician Assistant
MA065595
PA
Other
Enumeration date
06/17/2024
Last updated
02/03/2025
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