Healthcare Provider Details

I. General information

NPI: 1417550666
Provider Name (Legal Business Name): ASHLEY NICOLE MALLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE ROHLFS

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N FRANKLIN ST
LANCASTER PA
17602-2176
US

IV. Provider business mailing address

625 S GODDARD BLVD APT 105
KING OF PRUSSIA PA
19406-2017
US

V. Phone/Fax

Practice location:
  • Phone: 717-295-2323
  • Fax:
Mailing address:
  • Phone: 484-252-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062027
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: