Individual
MEARA MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-7400
(414) 805-7388
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-7400
(414) 805-7388
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
7046
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2022
Last updated
08/25/2022
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