Individual
TARA MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
5705 SEPTEMBER LN, ROSCOMMON, MI 48653-8756
(989) 325-0576
Mailing address
5705 SEPTEMBER LN, ROSCOMMON, MI 48653-8756
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703083153
MI
Other
Enumeration date
01/20/2026
Last updated
01/20/2026
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