Provider Demographics
NPI:1912641689
Name:MALLOW, JESSICA DAWN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:MALLOW
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3569
Mailing Address - Country:US
Mailing Address - Phone:304-591-3508
Mailing Address - Fax:
Practice Address - Street 1:909 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4109
Practice Address - Country:US
Practice Address - Phone:304-591-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74838163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health