| Mallori Wisuri Hathaway, PA-C | |
|
1428 N Gardner St, Scottsburg, IN 47170-8720 | |
| (812) 752-3512 | |
| (812) 752-8593 |
| Full Name | Mallori Wisuri Hathaway |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 3 Years |
| Location | 1428 N Gardner St, Scottsburg, Indiana |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861019689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 10003222A (Indiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Scott Memorial Health | Scottsburg, IN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Forefront Dermatology | 3779471701 | 483 |
| Mailing Address | Practice Location Address |
|---|---|
| Mallori Wisuri Hathaway, PA-C 801 York St, Manitowoc, WI 54220-4630 Ph: (920) 663-9008 | Mallori Wisuri Hathaway, PA-C 1428 N Gardner St, Scottsburg, IN 47170-8720 Ph: (812) 752-3512 |
Ms. Rebecca Sue Koopman, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 705 Fairground Rd, Scottsburg, IN 47170 Phone: 812-752-0165 | |
Tyler Jordan Satterfield, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1451 N Gardner St, Scottsburg, IN 47170 Phone: 812-752-3456 | |
Mrs. Adrienne D Parks, PAC Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 1441 N Gardner St, Scottsburg, IN 47170 Phone: 812-752-4055 Fax: 812-752-4188 |