Individual
WILLIAM GUNTHER MALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
137583-030
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
28182298A
IN
367500000X
Certified Registered Nurse Anesthetist
470412917
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000602388
ANTHEM PROVIDER NUMBER
IN
01
—
026511
AANA/CRNA
—
05
—
200929030
—
IN
Enumeration date
10/23/2006
Last updated
03/22/2010
Update your record
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