Basic Information
| Provider Information | |||||||||
| NPI: | 1255009056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCARTHUR | ||||||||
| FirstName: | MALLORY | ||||||||
| MiddleName: | ALEXIS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 LURTON ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060531307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032127592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 444 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060403926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2021 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 126588 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.