Individual
KATHLEEN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6485 MORGAN LA FEE LN, FORT MYERS, FL 33912-1644
(239) 433-1749
Mailing address
6485 MORGAN LA FEE LN, FORT MYERS, FL 33912-1644
(239) 433-1749
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP 1389652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034758200
—
FL
Enumeration date
01/21/2007
Last updated
10/01/2010
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