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General NPI Number Information
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NPI Number | 1215537287
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Entity Type | Individual
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Provider Name | CAROLYN ROSA MALLON APRN
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 112 PLEASANT ST STE 2B
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City | CONCORD
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State | NH
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Zip | 03301-2931
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Country | US
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Telephone | 603-852-0639
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Fax | 603-250-2370
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Provider Business Mailing Address
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Address Line | 75 S MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-4868
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Country | US
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Telephone | 603-852-0639
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Fax | 603-250-2370
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 066040-23
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License Number State | NH
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