Individual
TONYA MARIE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-9405
Mailing address
15510 COLLINGHAM DR, DETROIT, MI 48205-1345
(313) 526-6266
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704212472
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704212472
MI
Other
Enumeration date
11/16/2015
Last updated
01/10/2023
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