Individual
MARY LEANORA MALLERNEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
US HWY 491 N, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R49684
NM
363LF0000X
Family Nurse Practitioner
Primary
R49684
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42979323
—
NM
05
—
803735
—
AZ
05
—
99777533
—
CO
Enumeration date
10/26/2005
Last updated
01/16/2008
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