Provider Demographics
NPI:1609687656
Name:ANN MARIE MALLORY APRN, PLLC
Entity type:Organization
Organization Name:ANN MARIE MALLORY APRN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-608-6495
Mailing Address - Street 1:2620 REGATTA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6892
Mailing Address - Country:US
Mailing Address - Phone:702-648-6495
Mailing Address - Fax:
Practice Address - Street 1:2620 REGATTA DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6892
Practice Address - Country:US
Practice Address - Phone:702-608-6495
Practice Address - Fax:702-991-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty