Individual
LISA CARRIE ARCHAMBAULT MALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-9210
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
712821
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP113823
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173701702
—
TX
01
—
86412U
BCBSTX
TX
Enumeration date
05/30/2005
Last updated
09/30/2022
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