Individual
CHANDA ANN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED NURSE
Contact information
Practice address
9500 FRONT ST S STE 100, LAKEWOOD, WA 98499-9415
(253) 584-3996
Mailing address
9500 FRONT ST S STE 100, LAKEWOOD, WA 98499-9415
(253) 584-3996
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
61025157
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164W00000X
—
WA
Enumeration date
01/14/2020
Last updated
01/14/2020
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