Search › Indiana › 202C00000X
Fanta Mallard, MEDICAL ASSISTANT
NPI 1598490013 · on the registry since 2022 · sole proprietor
Practice
- Address
- 578 Tennessee St
Gary, IN 46402 - Phone
- (312) 241-3044
Registry record
- Primary taxonomy
- 202C00000X
202C00000X
- Also registered as
- 170100000X
172A00000X - Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-07-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana