Provider Demographics
NPI:1891072161
Name:MALLOZZI, ALISSA ANNE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ALISSA
Middle Name:ANNE
Last Name:MALLOZZI
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 1:304 UNION ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3437
Mailing Address - Country:US
Mailing Address - Phone:978-895-6379
Mailing Address - Fax:
Practice Address - Street 1:304 UNION ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3437
Practice Address - Country:US
Practice Address - Phone:978-895-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse