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Individual

KAYLA M WALLETTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AAS

Contact information

Practice address
1102 MAIN AVE, ROLLA, ND 58367
(701) 477-9050
Mailing address
200 HIGHWAY 2 W, DEVILS LAKE, ND 58301-3532
(701) 665-2200
(701) 665-2300

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary

Other

Enumeration date
03/06/2020
Last updated
03/06/2020
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