Individual
LISA WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C, CWS
Contact information
Practice address
160 SAWGRASS DR STE 130, ROCHESTER, NY 14620-4655
(585) 262-9100
(585) 256-2046
Mailing address
160 SAWGRASS DR STE 130, ROCHESTER, NY 14620-4655
(585) 262-9100
(585) 256-2046
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
30302641
NY
363L00000X
Nurse Practitioner
302641
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
302641
NY
Other
Enumeration date
07/31/2006
Last updated
07/05/2023
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