Individual
ELIZABETH WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7400 FRANCE AVE S STE 100, EDINA, MN 55435-4738
(763) 537-6000
Mailing address
596 OTTAWA AVE, SAINT PAUL, MN 55107-2528
(651) 707-7771
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
13183
MN
Other
Enumeration date
10/28/2019
Last updated
10/28/2019
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