Provider Demographics
NPI:1578339164
Name:BELANGER, MALLORY YEATON
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:YEATON
Last Name:BELANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 WINTER ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5415
Practice Address - Country:US
Practice Address - Phone:603-527-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075906-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care