Individual
PENNY SUE WALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
735 E CHICAGO ST, BRONSON, MI 49028-1349
(517) 858-1400
(517) 858-1403
Mailing address
677 E MAIN ST, CENTREVILLE, MI 49032-8524
(269) 467-1000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28167664A
IN
163W00000X
Registered Nurse
4704167228
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704167228
MI
Other
Enumeration date
05/25/2016
Last updated
02/02/2024
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