Individual
AMY D WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Mailing address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
100507
IA
363LF0000X
Family Nurse Practitioner
71002282A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275598864
WELLMARK BLUE CROSS BLUE SHIELD
IA
05
—
1275598864
—
IA
05
—
200848020A
—
IN
01
—
CG3197
MEDCARE RAILROAD GROUP
IN
01
—
P00456554
RAILROAD MEDICARE
IN
Enumeration date
04/18/2006
Last updated
10/06/2011
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