Provider Demographics
NPI:1588110795
Name:STANISLAWCZYK, MALLORY ELIZABETH MORRIS (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ELIZABETH MORRIS
Last Name:STANISLAWCZYK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1475 TANEY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4747
Mailing Address - Country:US
Mailing Address - Phone:301-662-0133
Mailing Address - Fax:
Practice Address - Street 1:1475 TANEY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4747
Practice Address - Country:US
Practice Address - Phone:301-662-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR223524363LP0200X
PASP016104363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics