Johansen, Mallory M.

Johansen, Mallory M. is an individual health care provider with primary practice located at 501 E. Hampden Ave. , Englewood CO 80113-2702. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Johansen, Mallory M. can be contacted via phone (303) 788-6911.

Contact Information

Primary practice address
501 E. Hampden Ave. Englewood CO 80113-2702
Phone: (303) 788-6911
Fax: (303) 306-7753
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X Colorado
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.0004112 Colorado

Profile Details

NPI number 1457753626
LBN Legal business name Johansen, Mallory M.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2014
Last updated Jun 10th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457753626 NPPES
Colorado MEDICAID 96028343

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