Individual
IESHA L MALLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13304 LEESVILLE CHURCH RD, RALEIGH, NC 27617-5206
(919) 845-5276
Mailing address
13304 LEESVILLE CHURCH RD, RALEIGH, NC 27617-5206
(919) 845-5276
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
190522
NC
363L00000X
Nurse Practitioner
5013679
NC
363LF0000X
Family Nurse Practitioner
Primary
5013679
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052019
N/A
NC
Enumeration date
09/11/2020
Last updated
11/01/2022
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