Individual
DR. NICOLE MARIE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 GRANT BLVD W, WABASHA, MN 55981-1042
(651) 565-4531
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35089618
OH
207P00000X
Emergency Medicine Physician
Primary
70944
MN
Other
Enumeration date
06/06/2007
Last updated
07/12/2022
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