Mallory, Theresa
Mallory, Theresa is an individual health care provider with primary practice located at 10 Willard Street , Quincy MA 02169. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Mallory, Theresa can be contacted via phone (617) 479-1437.Contact Information
Primary practice address
10 Willard Street
Quincy MA 02169
Phone: (617) 479-1437
Fax: (617) 479-3500
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 128754 | Massachusetts |
Profile Details
| NPI number | 1568431161 |
|---|---|
| LBN Legal business name | Mallory, Theresa |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 16th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568431161 | NPPES |
| Massachusetts | Other | N318 | HPHC |
| Massachusetts | MEDICAID | 357472 | HPHC |
| Massachusetts | Other | NP2083 | HPHC |
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