Individual
MALLORI WISURI HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1428 N GARDNER ST, SCOTTSBURG, IN 47170-8720
(812) 752-3512
(812) 752-8593
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003222A
IN
Other
Enumeration date
06/27/2020
Last updated
11/12/2025
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