Healthcare Provider Details

I. General information

NPI: 1871842609
Provider Name (Legal Business Name): MALLORY DUBOIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALLORY LAVIGNE APRN

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CLINTON ST
CONCORD NH
03301-2359
US

IV. Provider business mailing address

36 CLINTON ST
CONCORD NH
03301-2359
US

V. Phone/Fax

Practice location:
  • Phone: 603-271-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number066476-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: