Individual
MALLORY A PLUNKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6000
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2131
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
162-017
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100100845
—
WI
Enumeration date
04/14/2020
Last updated
06/26/2023
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