Individual
SANETTRA MAE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 TAFT CT STE 200, ROCKVILLE, MD 20850-1390
(240) 614-4241
Mailing address
2 TAFT CT STE 200, ROCKVILLE, MD 20850-1390
(240) 614-4241
(833) 903-0216
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
LP95133
MD
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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