Individual
BRENDA WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
505 S JOHN REDDITT DR, LUFKIN, TX 75904-3120
(936) 639-3036
(936) 639-3064
Mailing address
PO BOX 151736, LUFKIN, TX 75915-1736
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
072151
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84275U
BCBS
TX
01
—
84279U
BCBS
TX
Enumeration date
07/14/2006
Last updated
03/05/2008
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