NPI | 1659510030 |
---|---|
Former Name | BRE'ANNE B MALLON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704244156) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168166) |
Enumeration Date | 2009-02-09 |
Last Update Date | 2012-10-12 |