Provider Demographics
NPI:1205575123
Name:POCHOP, MALLORY N (MS, RD, LMNT, LD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:N
Last Name:POCHOP
Suffix:
Gender:F
Credentials:MS, RD, LMNT, LD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:N
Other - Last Name:FANGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4401
Mailing Address - Country:US
Mailing Address - Phone:408-844-8126
Mailing Address - Fax:402-955-3674
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4401
Practice Address - Country:US
Practice Address - Phone:408-844-8126
Practice Address - Fax:402-955-4184
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered