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Teresa Mallow
Gerontology Nurse Practitioner in St Louis Park, Minnesota
NPI 1396055851

Teresa Mallow is a Gerontology Nurse Practitioner based in Saint Paul, MN and is specialized in Gerontology. Teresa Mallow practices in St Louis Park, MN. The NPI Number for Teresa Mallow is 1396055851 and holds a License No. A0810006 (Minnesota).

The current practice location address for Teresa Mallow is 6500 Excelsior Blvd, St Louis Park, MN and can be reached out via phone at 952-993-3123.

Location: 6500 Excelsior Blvd, St Louis Park, MN, 55116-2241
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1396055851
Provider Name
Teresa Mallow
Credential
Provider Entity Type
Individual
Gender
Female
Address
6500 Excelsior Blvd, St Louis Park, MN, 55116-2241
Phone Number
952-993-3123
Fax Number
Provider Enumeration Date
10/19/2010
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
6500 Excelsior Blvd
City
St Louis Park
State
Minnesota
Zip
55426-4702
Phone Number
952-993-3123
Fax Number
person
Provider Business Mailing Address Details
Address
6500 Excelsior Blvd
City
St Louis Park
State
Minnesota
Zip
55426-4702
Phone Number
952-993-3123
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Adult Health
Taxonomy
363LA2200X
License No.
G0810008 (Minnesota)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Gerontology
Taxonomy
363LG0600X
License No.
A0810006 (Minnesota)
Definition
Definition to come...
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