Provider Demographics
NPI:1285432781
Name:STOLDORF, MALLORY
Entity type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:
Last Name:STOLDORF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2140
Mailing Address - Country:US
Mailing Address - Phone:531-400-1237
Mailing Address - Fax:
Practice Address - Street 1:3939 N 48TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1464
Practice Address - Country:US
Practice Address - Phone:531-225-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist