Individual
MALLORI WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3850 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 883-1000
Mailing address
8170 33RD AVE S, PO BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12110
MN
Other
Enumeration date
01/19/2016
Last updated
04/02/2020
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