NPI 1093385072

Mallory Michelle Light, CRNA

Practitioner Certified Registered Nurse Anesthetist Mattoon, IL

Practice location

Address: 1000 Health Center Dr, Mattoon, IL 61938-4644
Phone: (217) 258-2440
Fax: (217) 258-2186
Mailing address: 1005 Health Center Dr STE 201, Mattoon, IL 61938-4653

Registered specialties (2)

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence 209-026738 (IL)

Other Nurse Anesthetist, Certified Registered providers in Illinois →

Certified Registered Nurse Anesthetist

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence 2023001550 (MO)

Registry record

NPI: 1093385072
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Jun 2021
Record last updated: 20 Feb 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.