Provider Demographics
NPI:1336558527
Name:HATMAKER, MALLORY ELLEN (NP)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ELLEN
Last Name:HATMAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:DRAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1587 RYDALMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1349
Mailing Address - Country:US
Mailing Address - Phone:440-813-1570
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC
Practice Address - Street 2:9500 EUCLID AVE- WELLNESS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:440-813-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16118-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAG0614140OtherAANP