Provider Demographics
NPI:1417551565
Name:MARANTO, MALLORY NICOLE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:NICOLE
Last Name:MARANTO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:817-347-9601
Practice Address - Fax:817-347-9602
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1010447363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics