Individual
MALLORY RICH SHATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
190 KIMEL PARK DR STE 155, WINSTON SALEM, NC 27103-6946
(336) 765-6637
(336) 765-6964
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 765-6637
(336) 765-6964
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5021115
NC
363LA2100X
Acute Care Nurse Practitioner
1-159191
AL
Other
Enumeration date
03/12/2019
Last updated
12/30/2024
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