Provider Demographics
NPI:1093511982
Name:STOK, MALLORY JEAN (FNP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:JEAN
Last Name:STOK
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FRONT ST APT 227
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4849
Mailing Address - Country:US
Mailing Address - Phone:401-757-1202
Mailing Address - Fax:
Practice Address - Street 1:51 FRONT ST APT 227
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4849
Practice Address - Country:US
Practice Address - Phone:401-757-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2352059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse