Individual
ETHAN HENRY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1230 MONITOR ST, WENATCHEE, WA 98801-3534
(509) 232-5766
(509) 321-5472
Mailing address
12715 E MISSION AVE, SPOKANE VALLEY, WA 99216-1027
(509) 232-5766
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60979203
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2077844
—
WA
Enumeration date
09/09/2019
Last updated
09/09/2019
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