MALLORY LYNN BACON (NPI# 1669910097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669910097 |
| Entity Type | Individual |
| Full Name | MALLORY LYNN BACON |
| Practice Address |
822 Pulaski St Lincoln IL 62656-2902 |
| Practice Telephone | 2178719181 |
| Mailing Telephone | 2178719181 |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
822 PULASKI ST |
| City | LINCOLN |
| State | IL |
| Zip Code | 62656-2902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437678943 | Carissa Jo O'donoghue | Speech-Language Pathologist | 1000 Railer Way, Lincoln, IL 62656 | 2017-09-15 |
| 1083972012 | Cynthia Dorchinecz | Speech-Language Pathologist | 200 Fifth Street, Lincoln, IL 62656 | 2012-04-27 |
| 1104100114 | Jan E Fehrenbacher | Pharmacist | 603 Woodlawn, Lincoln, IL 62656 | 2011-10-10 |
| 1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
| 1649428756 | Diane E Ulrich | Dentist | 400 N. Chicago St, Lincoln, IL 62656 | 2008-09-03 |
| 1922202944 | Robert C Miller | Dentist | 217 S Kickapoo St, Lincoln, IL 62656 | 2007-06-13 |
| 1720290638 | Lifetime Dental Care of Illinois, PC | Dentist | 411 Keokuk Street, Lincoln, IL 62656 | 2007-05-04 |
| 1982734539 | Wal-mart Stores, Inc. Dba Wal-mart | Technician/Technologist | 825 Malerich Dr., Lincoln, IL 62656 | 2007-03-06 |
| 1861571663 | David R Hepler II | Chiropractor | 2000 Pulaski Street, Lincoln, IL 62656 | 2006-11-03 |
| 1477561793 | Raymond Todd Nobbe | Optometrist | 1400 Woodlawn Road, Lincoln, IL 62656 | 2006-08-03 |
| Find all providers in zip 62656 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912539289 | Jaclyn Taylor Masek | Student in an Organized Health Care Education/Training Program | 5000 Saint Paul Ave # Smb6141, Lincoln, NE 68504-2760 | 2020-02-05 |
| 1396375903 | Emma Louise Peterson | Student in an Organized Health Care Education/Training Program | 5000 Saint Paul Ave # Smb9020, Lincoln, NE 68504-2760 | 2020-01-22 |
| 1770046625 | Jessica Lindbeck | Student in an Organized Health Care Education/Training Program | 3428 Neerpark Dr, Lincoln, NE 68506-4527 | 2019-04-08 |
| 1528525615 | Ethan Griffith | Student in an Organized Health Care Education/Training Program | 3251 Fair St, Lincoln, NE 68503-1327 | 2019-02-25 |
| 1134498330 | Daniel Timothy Smith | Student in an Organized Health Care Education/Training Program | 1500 S 48th St Ste 506, Lincoln, NE 68506-1279 | 2011-12-19 |
| 1891073102 | Michelle A Gardner | Student in an Organized Health Care Education/Training Program | 3800 S 48th St, Lincoln, NE 68506-4345 | 2011-08-03 |
| 1437449568 | Caroline Belshe | Student in an Organized Health Care Education/Training Program | 22 Bernon Dr, Lincoln, RI 02865-2332 | 2011-04-11 |
| 1316263130 | Daniel J Tylka | Student in an Organized Health Care Education/Training Program | 1100 Cambridge Ct, Apartment 1, Lincoln, NE 68505-1771 | 2010-04-19 |
| 1518299981 | Renu Alex Thomas | Student in an Organized Health Care Education/Training Program | 2223 Vine St, Apt 5, Lincoln, NE 68503-2456 | 2010-02-09 |
| 1194962167 | Elijah Dacy | Student in an Organized Health Care Education/Training Program | 1100 Vale St, Lincoln, NE 68521-2068 | 2009-01-13 |
| Find all providers in LINCOLN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.