Provider Demographics
NPI:1598389496
Name:MALLON, BETHANN (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:MALLON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENLLYN BLUE BELL PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1670
Mailing Address - Country:US
Mailing Address - Phone:610-222-9000
Mailing Address - Fax:
Practice Address - Street 1:830 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1670
Practice Address - Country:US
Practice Address - Phone:610-222-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022007363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health