Individual
BRENDA DIANE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160/163 BUILDING KA 2010, KAYENTA, AZ 86033-0368
(928) 697-4100
(928) 697-4029
Mailing address
280 VALLEY ST, SPARTA, TN 38583-3210
(423) 322-0166
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
NURR34341
AK
163W00000X
Registered Nurse
Primary
RN0000037956
TN
163WE0003X
Emergency Registered Nurse
37956
TN
163WE0003X
Emergency Registered Nurse
NURR34341
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
07/14/2014
Last updated
07/14/2014
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