Individual
ALEXANDRA WALLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
91 CEDAR LANE, MEDFORD, NY 11763
(631) 617-0952
Mailing address
91 CEDAR LN, MEDFORD, NY 11763-1169
(631) 617-0952
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303037
NY
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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