Individual
MISS NICHOELLE RENEE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5304 N ROAD 68, PASCO, WA 99301-8078
(509) 543-9300
(509) 542-3059
Mailing address
589 NW 11TH ST, HERMISTON, OR 97838-6600
(541) 567-1717
(541) 564-5994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA156832
OR
Other
Enumeration date
11/04/2008
Last updated
04/15/2019
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