Provider Demographics
NPI:1780155762
Name:PALOMBIT, MALLORY ROSE (NP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ROSE
Last Name:PALOMBIT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:11166 CHERRYLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8104
Mailing Address - Country:US
Mailing Address - Phone:248-849-5806
Mailing Address - Fax:248-849-5489
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4311
Practice Address - Fax:248-465-4651
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-03-20
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Provider Licenses
StateLicense IDTaxonomies
MI4704286836363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner