Provider Demographics
NPI:1073235446
Name:MALLORY, RACHELLE ELVINA CALDWELL (RN)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ELVINA CALDWELL
Last Name:MALLORY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:ELVINA
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2348 S PASEO LOMA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6444
Mailing Address - Country:US
Mailing Address - Phone:480-686-0003
Mailing Address - Fax:
Practice Address - Street 1:855 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3401
Practice Address - Country:US
Practice Address - Phone:480-472-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN167426163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool