Individual
MATTIE MCALLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
28 N 64TH ST, BELLEVILLE, IL 62223-3808
(314) 991-0985
(908) 653-9305
Mailing address
PO BOX 822344, PHILADELPHIA, PA 19182-2344
(314) 991-0985
(908) 653-9305
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
046846
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046846
MEDICAL LICENSE
MO
Enumeration date
05/07/2007
Last updated
07/08/2007
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