Individual
MALLORY R. WALTRIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
900 N 1ST ST, SPRINGFIELD, IL 62702-3749
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209015762
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209015762
IL
Other
Enumeration date
03/16/2017
Last updated
04/07/2026
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