Individual
MRS. ANDREA S. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
10109 E 79TH ST, TULSA, OK 74133-4564
(918) 286-5131
(918) 249-7532
Mailing address
10109 E 79TH ST, TULSA, OK 74133-4564
(918) 286-5131
(918) 249-7532
Taxonomy
Speciality
Code
Description
License number
State
163WS0121X
Plastic Surgery Registered Nurse
R31459
NM
363LA2100X
Acute Care Nurse Practitioner
Primary
R0086862
OK
Other
Enumeration date
02/15/2006
Last updated
02/22/2013
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