Individual
MALLORY ELIZABETH CUSUMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
224 S WOODS MILL RD STE 330S, CHESTERFIELD, MO 63017-3497
(143) 576-7013
(314) 576-4047
Mailing address
301 BAKER AVE, WEBSTER GROVES, MO 63119-3735
(636) 236-5602
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2018004643
MO
363LA2200X
Adult Health Nurse Practitioner
2018004643
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/04/2018
Last updated
05/20/2025
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