Provider Demographics
NPI:1932963584
Name:MCCALL, MALLORY ANN
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 EAGLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5533
Mailing Address - Country:US
Mailing Address - Phone:937-825-6428
Mailing Address - Fax:
Practice Address - Street 1:4740 EAGLEVIEW DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5533
Practice Address - Country:US
Practice Address - Phone:937-825-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver