Individual
MRS. NANCY WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1339 S PUEBLO BLVD, PUEBLO, CO 81005-1508
(719) 647-5831
(719) 647-5833
Mailing address
1339 S PUEBLO BLVD, PUEBLO, CO 81005-1508
(719) 647-5831
(719) 647-5833
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
120
CO
Other
Enumeration date
05/13/2008
Last updated
05/13/2008
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