Individual
ANNESSA FAYE VAN DE WALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
291 HARRIS DR, AUSTIN, TX 78737-4606
(817) 366-7542
Mailing address
291 HARRIS DR, AUSTIN, TX 78737-4606
(817) 366-7542
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
618160
TX
Other
Enumeration date
04/17/2012
Last updated
04/17/2012
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