Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
FANTA MALLARD, MEDICAL ASSISTANT
Active Sole ProprietorFANTA MALLARD, MEDICAL ASSISTANT is a 202C00000X healthcare provider located in GARY, Indiana. NPI 1598490013 is currently active in the NPPES registry. Verify at CMS.
202C00000X · GARY, IN
Registration Details
- NPI Number
- 1598490013
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jul 19, 2022 (4.099260479069 yrs)
- Last Updated
- Jul 19, 2022
- License
-
M6S9Q7R7 (IN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
578 TENNESSEE STGARY, IN, 464021438Browse IN providers · Browse ZIP 46402
- Phone
- 3122413044
- Primary Specialty
-
202C00000X
202C00000X
- Additional Specialty
- Driver
- Additional Specialty
- 202C00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.