Individual
DAVID WALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22 STATION AVE, BRUNSWICK, ME 04011-2092
(207) 406-7500
Mailing address
160 ALLEN STREET, MEDICAL STAFF SERVICES, RUTLAND, VT 05701
(802) 747-3639
(802) 747-6207
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2300
ME
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
03/21/2017
Last updated
05/19/2023
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