Individual
MARY B WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 W MORENO ST, PENSACOLA, FL 32501-2316
(850) 434-4858
Mailing address
2160 HALLMARK DR, PENSACOLA, FL 32503-3317
(850) 470-9615
(850) 470-9615
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP2947442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302213700
—
FL
01
—
G2209
BSFL
FL
Enumeration date
01/04/2006
Last updated
11/24/2010
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