Individual
MRS. GLORIA AGNES WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
225 N BEAUMONT RD, SUITE 306, PRAIRIE DU CHIEN, WI 53821-1445
(608) 326-0230
(608) 326-0289
Mailing address
225 N BEAUMONT RD, SUITE 306, PRAIRIE DU CHIEN, WI 53821-1445
(608) 326-0230
(608) 326-0289
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
50568-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41861300
—
WI
05
—
44005700
—
WI
Enumeration date
05/31/2007
Last updated
07/08/2007
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