Provider Demographics
NPI:1871331066
Name:CHRIST, MALLORY KAY (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:KAY
Last Name:CHRIST
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:KAY
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3626
Mailing Address - Country:US
Mailing Address - Phone:715-685-5500
Mailing Address - Fax:
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3626
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1104221163WC0200X
WI151986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine