Individual
ANGELA O WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
300 HIGHLAND BLVD, SUITE B, NATCHEZ, MS 39120-4600
(601) 304-2421
Mailing address
530 DEMOSS STREET, LORDSBURG, NM 88045-4600
(575) 542-8384
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP04732
LA
363LF0000X
Family Nurse Practitioner
Primary
CNP65978
NM
363LF0000X
Family Nurse Practitioner
R853759
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04705271
—
MS
05
—
1343447
—
LA
Enumeration date
05/08/2006
Last updated
01/10/2022
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