Individual
STACY S MALLARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10954 HILLTOP LN, COLUMBIA, MD 21044-3780
(410) 718-3213
Mailing address
10954 HILLTOP LN, COLUMBIA, MD 21044-3780
(410) 718-3213
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R186082
MD
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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