Individual
ELIZABETH WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 CALLE CAL, SANTA FE, NM 87508
(614) 266-8533
Mailing address
20 CALLE CAL, SANTA FE, NM 87508-9158
(614) 266-8533
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35055437
OH
208000000X
Pediatrics Physician
35-055437
OH
208D00000X
General Practice Physician
Primary
35.055437
OH
208D00000X
General Practice Physician
MD000025868
NM
208D00000X
General Practice Physician
MD43857E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0665945
—
OH
Enumeration date
07/22/2005
Last updated
05/15/2018
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