Individual
MR. SPENCER WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2781
(719) 584-4306
(719) 595-7886
Mailing address
400 W 16TH ST, PUEBLO, CO 81003-2781
(719) 584-4306
(719) 595-7886
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ANP.0993430-NP
CO
Other
Enumeration date
10/03/2017
Last updated
03/29/2018
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