Most Relevant Information
Provider Data
| NPI Number: | 1003659020 |
| Provider Name: | AUTUMN NICOLE MALLIARD PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AS0400X |
| Specialty: | Physician Assistant |
| License Number: | MA065595 |
Most Important Dates
| Enumeration Date: | 06/17/2024 |
| Last Updated: | 10/15/2024 |
Provider Practice Location
100 HOSPITAL AVE
DU BOIS
PA
158011440
Practice Location Phone/Fax
| Phone: | 8143712200 |
| Fax: |
Provider Mailing Location
100 HOSPITAL AVE
DU BOIS
PA
158011440
Provider Mailing Phone/Fax
| Phone: | 8147155509 |
| Fax: |