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Individual
AMY L WALLIN
Active
Individual
AMY L WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD-32980
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0186809
—
IA
05
—
1104804087
—
IA
01
—
370013781
RR MEDICARE
IA
Enumeration date
01/03/2006
Last updated
02/11/2015
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