Provider Demographics
NPI:1679346761
Name:MALLARD, MILDRED RENEE
Entity type:Individual
Prefix:MISS
First Name:MILDRED
Middle Name:RENEE
Last Name:MALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3247
Mailing Address - Country:US
Mailing Address - Phone:216-372-5269
Mailing Address - Fax:
Practice Address - Street 1:25 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3247
Practice Address - Country:US
Practice Address - Phone:216-372-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker