Provider Demographics
NPI:1598231904
Name:MALLETTE, ALLISON ANNE (NP)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:ANNE
Last Name:MALLETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:ANNE
Other - Last Name:MALLETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13100 MANCHESTER RD STE 70
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13100 MANCHESTER RD STE 70
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1703
Practice Address - Country:US
Practice Address - Phone:314-492-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013025085163W00000X
MO2018035534363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse