Provider Demographics
NPI:1962920603
Name:MEHL, MALLORY ANN (FNP)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANN
Last Name:MEHL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 RALEIGH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1384
Mailing Address - Country:US
Mailing Address - Phone:386-316-0567
Mailing Address - Fax:
Practice Address - Street 1:761 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5644
Practice Address - Country:US
Practice Address - Phone:303-783-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993366208200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery