Individual
PROF. JENNIFER A MALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
SPRUCE STREET, MORGANTOWN, WV 26506
(304) 293-1402
Mailing address
PO BOX 9620, 6613 HEALTH SCIENCES SOUTH, MORGANTOWN, WV 26506-9620
(304) 293-1402
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
56084
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1475
WV RX #
WV
Enumeration date
11/03/2006
Last updated
12/20/2010
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