Provider Demographics
NPI:1568298578
Name:ZEDELLA, MALLORY (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:ZEDELLA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 LAWNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5544
Mailing Address - Country:US
Mailing Address - Phone:937-305-3512
Mailing Address - Fax:
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR STE 160
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-3994
Practice Address - Country:US
Practice Address - Phone:937-436-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner