Provider Demographics
NPI:1437985959
Name:NELSON, MALLORY JOY (MSN, BSN, RN, APRN)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:JOY
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSN, BSN, RN, APRN
Other - Prefix:MISS
Other - First Name:MALLORY
Other - Middle Name:JOY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2047
Mailing Address - Country:US
Mailing Address - Phone:330-413-5809
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2614
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.441765163WC0200X
OHAPRN.CNP.0037966363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine