Individual
ANGELA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NREMT-P
Contact information
Practice address
311 MAIN ST, SONORA, KY 42776-9707
(270) 307-7511
Mailing address
311 MAIN ST, SONORA, KY 42776-9707
(270) 307-7511
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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