Individual
NICOLE M MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
28800 RYAN RD, WARREN, MI 48092-4272
(586) 573-6400
(586) 576-1918
Mailing address
1431 WASHINGTON BLVD, APT 1716, DETROIT, MI 48226-1732
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003330
MI
Other
Enumeration date
03/14/2008
Last updated
03/17/2008
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