Provider Demographics
NPI:1922504299
Name:HENSEL, MALLORY (MSN, CRNP, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HENSEL
Suffix:
Gender:F
Credentials:MSN, CRNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 RODMAN ST APT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1433
Mailing Address - Country:US
Mailing Address - Phone:215-620-2536
Mailing Address - Fax:
Practice Address - Street 1:536 RODMAN ST APT A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1433
Practice Address - Country:US
Practice Address - Phone:215-620-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN653855163W00000X
PASP018580363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology