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Individual
MISS MARY JEAN WALLIN
Active
Individual
MISS MARY JEAN WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED NURSE MIDW
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
367A00000X
Advanced Practice Midwife
0023
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6540104
—
SD
Enumeration date
06/27/2005
Last updated
10/17/2018
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