Individual
MALLORY ANN MYSLENSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
2122 HEALTH DR SW STE 133, WYOMING, MI 49519-9698
(616) 252-5950
(616) 252-5956
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704301141
MI
363L00000X
Nurse Practitioner
AG06180160
MI
363LA2200X
Adult Health Nurse Practitioner
AG06180160
MI
363LG0600X
Gerontology Nurse Practitioner
AG06180160
MI
363LP2300X
Primary Care Nurse Practitioner
AG06180160
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366937716
—
MI
Enumeration date
06/28/2018
Last updated
02/05/2019
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