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Individual

ADAM WALLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
502 W SAINT LOUIS ST STE 4, WEST FRANKFORT, IL 62896-1968
(618) 937-3400
(618) 997-9324
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 937-3400
(618) 997-9324

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209021745
IL

Other

Enumeration date
08/04/2020
Last updated
05/23/2022
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