Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA.18458-NP | OH |
NPI | 1003281858 |
---|---|
Provider Name | Mallory Michelle Michna |
First Address | Nashville, TN 37214-3108 |
Second Address | Lebanon, OH 45036-8258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2015 |
Last Update Date | 18/11/2019 |