Provider Demographics
NPI:1730323486
Name:MALLON, LOU ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOU ANN
Middle Name:
Last Name:MALLON
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 1:2788 LOMBARDI AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-3307
Mailing Address - Country:US
Mailing Address - Phone:330-478-0628
Mailing Address - Fax:
Practice Address - Street 1:2788 LOMBARDI AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-3307
Practice Address - Country:US
Practice Address - Phone:330-478-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 142761163W00000X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health