Individual
MISS KIMBERLY MICHELLE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4707 N MALDEN ST, APT 303, CHICAGO, IL 60640-6917
(312) 975-3312
Mailing address
4707 N MALDEN ST, APT 303, CHICAGO, IL 60640-6917
(312) 975-3312
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043120655
IL
164W00000X
Licensed Practical Nurse
128873
OH
Other
Enumeration date
07/29/2013
Last updated
07/21/2016
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