| 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 |