Provider Demographics
NPI:1538392915
Name:MCCARTHY, MALLORY (RN)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:481 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04414-3529
Mailing Address - Country:US
Mailing Address - Phone:508-638-1665
Mailing Address - Fax:
Practice Address - Street 1:481 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BROWNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04414-3529
Practice Address - Country:US
Practice Address - Phone:508-638-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279098163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse