Individual
MS. MALLORY DRISCOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17025 SNOWMOBILE LN, EAGLE RIVER, AK 99577-7044
(907) 696-7466
Mailing address
17025 SNOWMOBILE LN, EAGLE RIVER, AK 99577-7044
(907) 696-7466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11674343-1206
UT
363A00000X
Physician Assistant
13162
MN
363A00000X
Physician Assistant
Primary
153300
AK
363A00000X
Physician Assistant
PAC0801
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478531
—
ND
05
—
1699289
—
AK
05
—
1972012482
—
MN
Enumeration date
09/27/2017
Last updated
05/23/2023
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