Individual
MRS. JOANNE WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1270 KOT-NUM ROAD, WARM SPRINGS, OR 97761-1209
(541) 553-1196
(541) 553-2135
Mailing address
1270 KOT-NUM ROAD, WARM SPRINGS, OR 97761-1209
(541) 553-1196
(541) 553-2135
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0017139524
VA
363LF0000X
Family Nurse Practitioner
Primary
389
AK
363LW0102X
Women's Health Nurse Practitioner
0017139524
VA
363LW0102X
Women's Health Nurse Practitioner
389
AK
Other
Enumeration date
06/16/2005
Last updated
02/02/2017
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