Individual
MALLORY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3101 SHIPPERS RD STE 106, VESTAL, NY 13850-2081
(607) 584-4549
Mailing address
3101 SHIPPERS RD STE 106, VESTAL, NY 13850-2081
(607) 644-4585
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
002309
NY
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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