Provider Demographics
NPI:1326399650
Name:HELLER, MALLORY THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:THOMAS
Last Name:HELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 12TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0719
Mailing Address - Country:US
Mailing Address - Phone:713-410-4002
Mailing Address - Fax:
Practice Address - Street 1:260 S KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1086
Practice Address - Country:US
Practice Address - Phone:303-232-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0202541163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health