Individual
LYDIA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10618 BRECKENRIDGE DR, LITTLE ROCK, AR 72211-1802
(501) 217-8600
(501) 217-8636
Mailing address
10618 BRECKENRIDGE DR, LITTLE ROCK, AR 72211-1802
(501) 217-8600
(501) 217-8636
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R027919
AR
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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