Individual
MIKAYLA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3702
Mailing address
434 SUNBURST RD, LYNCHBURG, VA 24501-7249
(434) 944-2860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008117
VA
Other
Enumeration date
06/28/2021
Last updated
10/08/2021
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