Provider Demographics
NPI:1255961959
Name:GROFF, MALLORY KRISTEN
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:KRISTEN
Last Name:GROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:KRISTEN
Other - Last Name:HODGKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MALLORY MARTHA
Mailing Address - Street 1:4023 KENNETT PIKE UNIT 234
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2018
Mailing Address - Country:US
Mailing Address - Phone:302-217-6020
Mailing Address - Fax:302-208-4943
Practice Address - Street 1:108 WALNUT RUN RD
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-9305
Practice Address - Country:US
Practice Address - Phone:302-217-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9426584163W00000X
MN7531363LP0808X
AK161921363LP0808X
NV828441363LP0808X
NDR48854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse