Individual
BRENT STEVEN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
3400 W BALL RD STE 207, ANAHEIM, CA 92804-3737
(714) 683-5100
Mailing address
766 S LANGTREE LN, ANAHEIM, CA 92807-4897
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95013038
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95013038
CA BRN
CA
Enumeration date
02/06/2020
Last updated
02/07/2020
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