Individual
CLARENCE WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
47082 OAK CREEK TRCE, HAMMOND, LA 70401-3641
(985) 956-7111
Mailing address
PO BOX 584, NATALBANY, LA 70451-0584
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
3747P1801X
Personal Care Attendant
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447824636
—
LA
Enumeration date
03/11/2022
Last updated
03/11/2022
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