Individual
MALLORY NICHOLE MATUSIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
519 N HALLECK ST, DEMOTTE, IN 46310-9553
(219) 987-7750
Mailing address
9811 W 145TH AVE, CEDAR LAKE, IN 46303-7258
(219) 484-7683
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28229514A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012811A
IN
Other
Enumeration date
07/21/2022
Last updated
07/23/2022
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