Individual
SUZANNE T MALLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7600 S HIGHWAY 69A, MIAMI, OK 74354-1016
(918) 542-1655
(918) 540-1685
Mailing address
9473 SE 80TH TER, BAXTER SPRINGS, KS 66713-3278
(620) 848-9826
(918) 540-1685
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
147011
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425773108
—
MO
Enumeration date
06/27/2006
Last updated
12/19/2012
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