Individual
MALLORY COTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6665 W GATE CT, ROSCOE, IL 61073-9642
(518) 524-3221
Mailing address
6665 W GATE CT, ROSCOE, IL 61073-9642
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041477774
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209025808
IL
Other
Enumeration date
05/06/2022
Last updated
08/27/2022
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