Individual
ASHLEY BROOKE WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11819 MIRACLE HILLS DR STE 105, OMAHA, NE 68154-4428
(402) 905-2075
Mailing address
3597 W CHERRY RD, PICKRELL, NE 68422-8091
(402) 239-2775
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2228
NE
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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