Provider Demographics
NPI:1316448418
Name:RICHARDSON, MALLORY (ARNP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1929
Mailing Address - Country:US
Mailing Address - Phone:319-861-7600
Mailing Address - Fax:319-861-7678
Practice Address - Street 1:543 7TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1929
Practice Address - Country:US
Practice Address - Phone:319-861-7600
Practice Address - Fax:319-861-7678
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA150411163W00000X
IAA181809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse