Individual
DYAN M MALLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9 MINER ST, CANTON, NY 13617-1208
(315) 386-8821
(315) 386-4723
Mailing address
35 WRIGHT CAMP DR, OGDENSBURG, NY 13669-4223
(315) 393-8955
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
333467
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00583697
—
NY
Enumeration date
03/07/2007
Last updated
03/07/2012
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