Provider Demographics
NPI:1528220399
Name:MALLET, MARGARET JAEL (RN)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:JAEL
Last Name:MALLET
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 1:159 ELM ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2603
Mailing Address - Country:US
Mailing Address - Phone:508-615-6945
Mailing Address - Fax:
Practice Address - Street 1:159 ELM ST
Practice Address - Street 2:UNIT 5
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2603
Practice Address - Country:US
Practice Address - Phone:508-615-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse