Healthcare Provider Details

I. General information

NPI: 1306728126
Provider Name (Legal Business Name): MALLORY ANDERSON TONNER BSN. RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PINES RD
SEARSMONT ME
04973-3818
US

IV. Provider business mailing address

15 PINES RD
SEARSMONT ME
04973-3818
US

V. Phone/Fax

Practice location:
  • Phone: 207-322-9144
  • Fax:
Mailing address:
  • Phone: 207-322-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN72109
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: