Healthcare Provider Details

I. General information

NPI: 1528645520
Provider Name (Legal Business Name): MALLORY FAYE HINDS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date: 03/26/2021
Reactivation Date: 08/19/2026

III. Provider practice location address

3509 E 29TH ST
DES MOINES IA
50317-4253
US

IV. Provider business mailing address

3600 49TH ST
DES MOINES IA
50310-2634
US

V. Phone/Fax

Practice location:
  • Phone: 515-248-1600
  • Fax:
Mailing address:
  • Phone: 515-802-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA190899
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: