Individual
SERENA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 MEADOW LAKE RD, LOS LUNAS, NM 87031-9449
(505) 865-9652
Mailing address
112 MEADOW LAKE RD, LOS LUNAS, NM 87031-9449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
88832
NM
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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