Individual
MS. MALLORY MICHELLE LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(217) 258-2440
(217) 258-2186
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4653
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2023001550
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209-026738
IL
Other
Enumeration date
06/30/2021
Last updated
02/20/2023
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