Individual
JOHN ROBERT WALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTIONER
Contact information
Practice address
16443 DELIA DR, BILOXI, MS 39532-9411
(228) 861-8505
Mailing address
16443 DELIA DR, BILOXI, MS 39532-9411
(228) 860-5164
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R850026
MS
Other
Enumeration date
02/02/2012
Last updated
11/30/2019
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