Individual
TERESA MALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3123
Mailing address
1521 HIGHLAND PKWY, SAINT PAUL, MN 55116-2241
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
A0810006
MN
363LG0600X
Gerontology Nurse Practitioner
G0810008
MN
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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