Mallon, Lisa Carrie Archambault

Mallon, Lisa Carrie Archambault is an individual health care provider with primary practice located at 2401 S 31St St , Temple TX 76508-9210. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Mallon, Lisa Carrie Archambault can be contacted via phone (254) 724-2111.

Contact Information

Primary practice address
2401 S 31St St Temple TX 76508-9210
Phone: (254) 724-2111
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 712821 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X AP113823 Texas

Profile Details

NPI number 1992708408
LBN Legal business name Mallon, Lisa Carrie Archambault
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2005
Last updated Sep 30th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992708408 NPPES
Texas MEDICAID 173701702
Texas Other 86412U

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