Individual
MS. SANDRA D WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, MSN
Contact information
Practice address
2861 BROAD AVE, MEMPHIS, TN 38112-2903
(901) 260-8500
(901) 325-6469
Mailing address
2595 CENTRAL AVE, MEMPHIS, TN 38104-5905
(901) 260-8551
(901) 260-8590
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN0000005098
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3346145
—
TN
Enumeration date
05/10/2006
Last updated
06/06/2012
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