Individual
MRS. MALLORY WILLIAMS GROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C
Contact information
Practice address
694 RIVERSIDE DR, MOUNT AIRY, NC 27030
(336) 719-7892
(336) 719-7898
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 719-7892
(336) 719-7898
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5005508
NC
363LA2200X
Adult Health Nurse Practitioner
363LA2200X
NC
Other
Enumeration date
03/01/2012
Last updated
08/02/2024
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