Individual
THERESA MALLORY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10 WILLARD STREET, QUINCY, MA 02169
(617) 479-1437
(617) 479-3500
Mailing address
10 WILLARD STREET, QUINCY, MA 02169
(617) 479-1437
(617) 479-3500
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
128754
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357472
—
MA
01
—
N318
HPHC
MA
01
—
NP2083
BC/BS
MA
Enumeration date
03/16/2006
Last updated
07/08/2007
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