Individual
SAMANTHA JEAN MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 467-4374
Mailing address
12130 YUKON AVE N, CHAMPLIN, MN 55316-3582
(612) 618-6724
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2444
MN
Other
Enumeration date
03/18/2007
Last updated
05/03/2011
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