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Individual

MRS. MALLORY GIBBONS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
21 EASTERN AVE, WORCESTER, MA 01605-3094
(508) 556-0223
Mailing address
21 EASTERN AVE, WORCESTER, MA 01605-3094
(508) 556-0223
(774) 420-2289

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN2269601
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN2269601
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110121244A
MA
Enumeration date
01/11/2017
Last updated
04/19/2022
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