Healthcare Provider Details

I. General information

NPI: 1538392915
Provider Name (Legal Business Name): MALLORY MCCARTHY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALLORY DODD RN

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 CHURCH ST
BROWNVILLE ME
04414-3529
US

IV. Provider business mailing address

481 CHURCH ST
BROWNVILLE ME
04414-3529
US

V. Phone/Fax

Practice location:
  • Phone: 508-638-1665
  • Fax:
Mailing address:
  • Phone: 508-638-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number279098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: