Individual
GAYLENE O WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
6393 W 4600 S, HOOPER, UT 84315-6753
(801) 985-7585
Mailing address
6393 W 4600 S, HOOPER, UT 84315-6753
(801) 985-7585
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
UT000212840909
UT
376K00000X
Nurse's Aide
Primary
UT000212840909
UT
Other
Enumeration date
10/30/2009
Last updated
10/30/2009
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