Individual
MALLORYE ANN BANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
106 W NORTH ST, CORTEZ, CO 81321-3119
(970) 565-3056
(970) 565-0647
Mailing address
106 W NORTH ST, CORTEZ, CO 81321-3119
(970) 565-3056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.1665815
CO
2083P0901X
Public Health & General Preventive Medicine Physician
RN.1665815
CO
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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