Individual
CARL G MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1128 HIDDEN OAK LN, LAKE CHARLES, LA 70605-7123
(337) 478-1085
Mailing address
1128 HIDDEN OAK LN, LAKE CHARLES, LA 70605-7123
(337) 478-1085
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
03828
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1115096
—
LA
01
—
P00140225
RAILROAD MEDICARE PIN
LA
Enumeration date
01/17/2006
Last updated
09/22/2010
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