Individual
JESSICA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 WHITE ST, DANVILLE, VA 24540-3848
(434) 203-2277
Mailing address
174 WHITE ST, DANVILLE, VA 24540-3848
(434) 203-2277
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180813930
—
VA
Enumeration date
05/19/2015
Last updated
10/04/2017
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