Provider Demographics
NPI:1306728126
Name:TONNER, MALLORY ANDERSON (BSN RN)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANDERSON
Last Name:TONNER
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3818
Mailing Address - Country:US
Mailing Address - Phone:207-322-9144
Mailing Address - Fax:
Practice Address - Street 1:15 PINES RD
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973-3818
Practice Address - Country:US
Practice Address - Phone:207-322-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN72109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse