Individual
MICHELLE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
26659 PLEASANT PARK RD, CONIFER, CO 80433-7714
(303) 647-5300
Mailing address
26659 PLEASANT PARK RD, CONIFER, CO 80433-7714
(303) 647-5300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA -1983
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-1983
LICENSE NUMBER
CO
Enumeration date
05/17/2006
Last updated
07/06/2015
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