Individual
MRS. STACIE M MALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
30865 130TH CT, WOODWARD, IA 50276-6209
(515) 490-9739
Mailing address
PO BOX 276, SLATER, IA 50244-0276
(515) 490-9739
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A157443
IA
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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