Individual
JULIE ANN MALLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1121 S INDIANA AVE, CROWN POINT, IN 46307-7205
(219) 663-2160
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002367A
IN
363LP2300X
Primary Care Nurse Practitioner
71002367
IN
Other
Enumeration date
02/20/2008
Last updated
03/12/2021
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