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General NPI Number Information
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NPI Number | 1881108462
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Entity Type | Individual
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Provider Name | MALLORY ELISE WILLETT
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Gender | Female
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Dates
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Enumeration Date | 11/19/2017
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 611 DUNCAN AVE
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City | PITTSBURGH
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State | PA
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Zip | 15237-5854
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Country | US
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Telephone | 412-358-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 INGHAM ST
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City | PITTSBURGH
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State | PA
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Zip | 15212-2840
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Country | US
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Telephone | 724-263-0741
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP018132
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License Number State | PA
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