Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mallory Fossa, PNP-PC

Individual provider Pediatric Nurse Practitioner · NPI 1780059030

Mallory Fossa, PNP-PC is a Pediatric Nurse Practitioner in Hartford, Connecticut. Practices as a sole proprietor and works from 2 locations. Licensed in California and Connecticut.

Licensed in
CA, CT
In the registry since
2015
Specialties on file
3
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Practice location Address checks out

282 Washington St
Hartford, CT 06106-3322
Phone: (860) 837-5207
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 — (323) 361-7686

Specialties & licences

Pediatric Anesthesiology Physician (primary) Taxonomy 207LP3000X · Licence 95003548 (CA)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 95003548 (CA)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 12.008276 (CT)

Record details

NPI number1780059030
Entity typeIndividual (Type 1)
GenderFemale
Credentials PNP-PC
Sole proprietorYes
NPI enumeratedDecember 10, 2015
Last updated in NPPESSeptember 12, 2022
Certification dateSeptember 12, 2022

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