Individual
MRS. MALLORY LANE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1600 S BRENTWOOD BLVD, DIV NEUROLOGY GENERAL, STE 600, SAINT LOUIS, MO 63144-1320
(314) 362-1408
(314) 362-0338
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-1408
(314) 362-0338
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2013012266
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220047038
—
MO
Enumeration date
04/20/2010
Last updated
04/17/2025
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