Individual
NYASHA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CM, LM
Contact information
Practice address
188 THROOP AVE STE 1R, BROOKLYN, NY 11206-5331
(347) 395-4082
Mailing address
4719 BEVERLEY RD, BROOKLYN, NY 11203-5227
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
002097
NY
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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