Individual
CHEYENNE MICHELE MALLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2359 STATE ROUTE 17, LA FAYETTE, IL 61449-9623
(309) 854-2579
Mailing address
2359 STATE ROUTE 17, LA FAYETTE, IL 61449-9623
(309) 854-2579
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041436220
IL
163W00000X
Registered Nurse
1020215
TX
163W00000X
Registered Nurse
143858
IA
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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