Individual
MALLORY MATHESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5900 LAKE WRIGHT DR, NORFOLK, VA 23502-1871
(757) 466-8683
Mailing address
5900 LAKE WRIGHT DR, NORFOLK, VA 23502-1871
(757) 466-8683
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2020
Last updated
08/23/2020
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