Provider Demographics
NPI:1285476358
Name:MALLORY, LINDA CAROL (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROL
Last Name:MALLORY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CADBURY RDG
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6125
Mailing Address - Country:US
Mailing Address - Phone:573-864-1052
Mailing Address - Fax:
Practice Address - Street 1:1225 CADBURY RDG
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-6125
Practice Address - Country:US
Practice Address - Phone:573-864-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.304561163W00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse